RFP , Attachment 5.4 County Ambulance Service Plan 1238

Transcription

1 BEFORE THE BOA OF CONTY COMMISSIONERS FOR MLTNOMAH CONTY, OREGON OINANCE NO Amending Multnomah County Code Chapter 21 Health Emergency Medical Services. (Language stricken is deleted; double underlined language is new.) The Multnomah County Board of Commissioners Finds: 1. ORS Chapter 682 describes the process through which the County regulates ambulance services. 2. ORS Chapter directs the County to develop a plan related to the coordination of ambulance services within the County. 3. The County has followed the public process outlined in state law to create a new ambulance service plan. 4. The Emergency Medical Services code must be amended to fully implement the plan adopted by this ordinance. 5. This ordinance and the Ambulance Service Plan will be effective September 1, 2018, when a new contract for ambulance services becomes effective. Multnomah County Ordains as Follows: RFP , Attachment 5.4 County Ambulance Service Plan 1238 Section 1. MCC is amended as follows: PRPOSE. (B) Ordinance 7-8-9(insert this Ordinance Number), passed June 9, 199/1(insert date passed), adopts the ambulance service plan for the County. This subchapter provides for the implementation of that plan. Section 2. MCC is amended as follows: DEFINITIONS. For the purpose of this subchapter, the following definitions shall apply unless the context requires a different meaning. Page 1 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

2 ADANCED LIFE SPPORT (ALS). Those medical services that may be provided within the scope of practice of a person certified licensed as an M-T Paramedic as defined in ORS Chapter and Oregon Administrative Rule. AMBLANCE. Any privately or publicly owned motor vehicle, aircraft, or water craft that is regularly provided or offered to be provided for the timely or emergency transportation of persons suffering from illness, injury, or disability, as defined by Oregon Administrative Rule. All vehicles capable of providing transportation to the sick or injured and staffed with personnel trained to care for such individuals and equipped with supplies and equipment necessary for the care of the sick or injured shall be considered an ambulance. BASIC LIFE SPPORT (BLS). Those medical services that may be provided within the scope of practice of a person certified as an EMT-Basic as defined in ORS Chapter 823 Oregon Administrative Rule. BREA OF EMERGENCY COMMNICATIONS (BOEC). The Bureau within the City of Portland that maintains the Primary Safety Answering Point (PSAP) 911 telephone answering system and the dispatch service for police, fire and EMS for the County. transports. DIISION or STATE. The EMS Emergency Medical Services and Trauma Systems Program, Public Health Division Oregon Health Division Authority. department of Human Resources. EMERGENCY MEDICAL SERICES (EMS). Those prehospital functions and services whose purpose is to prepare for and respond to medical and traumatic emergencies, including rescue and ambulance services, first responder services, ambulance services, patient care, communications, system evaluation, and public education. EMERGENCY MEDICAL SERICES (EMS) AGENCY or AGENCY. Means any person, partnership corporation governmental agency or unit, sole proprietorship or other entity that utilizes emergency medical services providers to provide prehospital emergency or non-emergency care. An emergency medical services agency may be either an ambulance service or a nontransporting service. EMERGENCY MEDICAL SERICES PROIDER (EMS PROIDER). Means a person who has received formal training in pre-hospital and emergency care and is statelicensed to attend to any ill, injured or disabled person. Police officers, firefighters, funeral home employees and other personnel serving in a dual capacity, one of which meets the definition of "Emergency Medical Services Provider" are "Emergency Medical Services Page 2 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

3 Providers" within the meaning of ORS Chapter 682 and Oregon Administrative Rule. This definition does not include people with this training operating without an ambulance or outside of the 911 medical call setting. EMERGENCY MEDICAL SYSTEM ADISORY CONCIL (EMSAC). council to the EMSMD and EMS Program. An advisory EMERGENCY MEDICAL TECHNICIAN (EMT). A person certifies licensed at one of the levels defined in ORS Chapter 82 Oregon Administrative Rule. EMERGENCY RESPONSE. Means an immediate response to a 911 medical call. An immediate response is one in which the ambulance provider begins as quickly as possible to take the steps necessary to respond to the call. It may include both responses with lights and siren and those without lights and siren. FIRST RESPONDER. fire departments throughout the county. Means an organization that provides rapid response to emergency medical calls utilizing licensed EMS Provider personnel. First responders aim to arrive and provide care prior to arrival of an ambulance. "HOSCAP." The on-line computer system provided and managed by the State. The purpose of HOSCAP is to create a link among all the receiving hospitals within the county that provides information on the status of those hospitals for receiving ambulance transports. HOSCAP was previously referred to as CHORAL. MEDICAL ADISORY BOA (MAB). The Advisory Committee appointed by the Board as defined in this subchapter. NON-EMERGENCY AMBLANCE. An ambulance, licensed by the county under this subchapter, that provides routine medical transportation to patients who do not require an emergency response. ON-LINE MEDICAL CONTROL. Medical direction and advice given to an -EMT EMS Provider, by a physician, through radio or telephone as a supplement to the written patient care protocols. Page 3 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

4 PROIDER. Any public, private or volunteer entity providing emergency medical services (EMS) or ambulance services, as defined in Oregon Administrative Rule or first response to medical emergencies. PBLIC SAFETY ANSWERING POINT (PSAP) or 911. The organization that answers calls for police, fire, and emergency medical assistance that are received from persons dialing 911. This service is provided by BOEC. RBAN GROWTH BONDARY (GB).The planning boundary developed by METRO that delineates the areas considered "urban" and "rural" for purposes of this subchapter. If METRO alters the GB, those changes shall take effect for this Chapter's purposes the following year beginning on January 1. SER FEES, EMSMD FEES, or FRANCHISE FEES. The fees established under the this code, payable by the provider to the county, for system administration, regulation, and medical supervision. Section 3. MCC is amended as follows: EXEMPTIONS. This subchapter shall not apply to the4ellowing: (A) ehicles owned or operated by the federal government; (C) ehicles operated solely on private property, the incidental crossing of public streets or roads not withstanding; or (D) Persons operating vehicles undcr divisions (A) through (C) of this section. any provider exempted by Oregon Revised Statute Section 4. MCC is amended as follows: LICENSE TYPES. (A) There shall be three four types of ambulance licenses available in the County: (1) Advanced Life Support (ALS); (2) Basic Life Support (BLS); and Page 4 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

5 (3) Air Ambulance: and (4) Critical Care Transport (CCT). (B) Marine ambulances shall be considered as either (A)(1) or (A)(2) above. (C) (CCT). (D)LCAMCEMS shall promulgate rules for each type of ambulance that specify staffing, equipment, supplies, use, operating policics, and other pertinent requirements for doing business in the County. (E)()) The authorization to respond to emergency medical calls is not a condition of license and such authorization must be separately obtained under (E) Medical standby or special events with Licensed EMS providers, with or without an ambulance must be performed through a County Licensed Agency. The County shall ensure coordination of standby services with the established emergency response system, and ensure appropriate transportation of patients. Section 5. MCC is amended as follows: AMBLANCE STAFFING. (A) Paramedics. ALS ambulances responding to emergency calls shall be staffed with two EMT (B) ALS ambulances transferring patients from hospitals to other facilities may be staffed at the minimum with one EMT Paramedic and one EMT-Basic. (C) such a license is required under this subchapter. CCT ambulances transferring patients from hospitals to other hospitals must be staffed with a minimum of a Licensed EMS staff member (EMT-Basic, EMT-Intermediate, Advanced EMT, or Paramedic), and at least one additional staff member that is a Nurse, Physician's Assistant, Medical Doctor, or Doctor of Osteopathy that must meet any and all requirements set by the State of Oregon EMS and Trauma to work on an ambulance. The staffing configuration requires approval by the EMSMD. (D) All other ambulances will be staffed with EMT-Basic or EMT-Intermediates whose orders and level of service will be specified by the EMSMD and which will allow for the medically appropriate transportation of patients with the most cost effective staffing. Page 5 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

6 (F) The staffing standards in subsections (A-D) of this section may be modified in accordance with the process in the Ambulance Service Plan. The process describes authority for changing standards, public involvement, and Board approval. Section 6. MCC is amended as follows: LICENSE REQIREMENTS. To obtain a license and remain a licensee, each applicant must: (E) Prohibit from practice, any EMT EMS Provider or EMT EMS Provider trainee who suffers suspension, revocation, or termination of certificate by the sstate Health Division, or who is not currently approved for practice by the EMSMD; Section 7. MCC is amended as follows: ISSANCE OF LICENSE. The administrator shall issue a license upon finding the following: (F) A schedule of charges for service have been filed with MCEMS. (1) A schedule of charges must include an itemized list of maximum allowable charges that the Licensee will be charging for all types of services offered within the County under the License. (2) The schedule may include but is not limited to the following charges: BLS, ALS, CCT mileage refusal/no transport fee, standby/special event services. Section 8. MCC is amended as follows: AMBLANCE IDENTIFICATION; ADERTISEMENT. (B) Ambulances under contract to the County for emergency medical response shall be identified as specified in the contract and no ambulance shall not display any telephone number other than "911." "Call 911 for Emergencies" shall be displayed on all licensed ambulances. Page 6 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

7 Section 9. MCC is amended as follows: PROHIBITED ACTIITIES. (E) Perform the services of an EMT EMS Provider unless authorized by state law, this subchapter, and the requirements adopted there under; Section 10. MCC is amended as follows: MEDICAL DIRECTION AND SPERISION. (B) The EMSMD shall serve as the physician supervisor for all EMTe., EMS Providers in the employ of licensed ambulance services within the county and working within the county. In addition, the EMSMD may shall serve as the physician supervisor for EMTs all EMS Providers employed by EMS 911 first responder agencies, by agreement with the County. (C) Duties of the EMSMD include, but are not limited to, the following: (1) Approval for practice for all EMTs EMS Providers. Approval shall be provided to each EMT EMS Provider and his or her employer, in writing, and a record kept by MCEMS; (2) Creation of policies for limiting the practice of EMTs EMS Providers when necessary, including adequate due process protections for the effected EMT EMS Provider; (3) Setting the standards for training and continuing education for EMTs EMS Providers and EMDs; (4) Implementation of a quality management program designed to provide for the continuous improvement of patient care and other aspects of the EMS system; (5) Promulgation of standards of patient care, consistent with the ambulance service area plan and including, but not limited to, the following: county; (a) (b) (c) Dispatch and pre-arrival protocols; Transport triage criteria and protocols; Specific requirements for EMTs EMS Providers working within the Page 7 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

8 (d) (e) (f) (g) (h) Approved equipment, supplies, and drugs; Patient care protocols; Medical criteria for response times; Patient transfer criteria; and Critical care interfacility transport criteria. (D)(1) The EMSMD may appoint assistants to help carry out the duties assigned to the medical director. The EMSMD retains the sole responsibility for all assigned duties. (2) Funding for assistants to the EMSMD, if any, shall be recommended by the administrator. (3) The EMSMD may enter into agreements to formalize duties of non-911 medical call medical supervision for non-franchised providers with additional assistants that are in employ with providers. (E) The EMSMD may appoint committees or individuals as deemed necessary, to provide advice regarding the duties of the medical director. (F) The EMSMD may not implement protocols nor take other actions that would change the patient care standards specifically identified in the ambulance service area plan or in this subchapter without approval by the Board. (G) The administrator is authorized to collect fees from employers of EMTs EMS Providers to off-set the cost to county for the EMSMD and any assistants. These fees shall be limited to the salary and benefits of the EMSMD and agents. Fees will change only with compensation changes. Section 11. MCC is amended as follows: A EtaA EMERGENCY MEDICAL SYSTEM ADISORY CONCIL (EMSAC). (A) There is created an EMS Emergency Mmedical System Aadvisory Council board WAR) which shall consist of the following persons: make recommendations and advise the EMSMD and EMS Program Administrator on EMS System innovations and improvements. American College of Emergency Physicians, and MRH; Page 8 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

9 at largo; {2) One physician, recomm e _ * _. (3) One nurse, specializing in emergency care, and recommended by the paramedics. (/1) Two paramedics recommended by organizations representing (B) Members shall be appointed by the Board for terms of throe years. The Council shall serve at the direction of the County Health Officer. (C) Responsibilities shall include the following: {1) Provision of advice to the EMSMD and MCEMS; and {2) An annual report to the Board on the effectiveness of prehospital medical care provided by the EMS system to the citizens of the county. The members of the Council shall be appointed by the Board, upon the recommendation of the EMS Administrator. The Council will be composed of a minimum of 12 members, with one third being Multnomah County community members who may access ambulance services {D) The chair of the MAB shall be appointed by the EMS medical director. (E)n Members shall be reimbursed for expenses authorized by the administrator. Section 12. MCC is amended as follows: TRAINING AND EDCATION. (A) All training and continuing education for EMTSEMS Providers will be provided through a coordinated educational program approved by the EMSMD. (C) Current and additional training and education resources from the public and private sectors will be used to provide these activities to EMTsEMS Providers. They will be coordinated to insure their maximum use and availability. (E) Training and education standards, E-MTEMS Provider attendance requirements, and county specific education and training requirements shall be the responsibility of the EMSMD. Page 9 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

10 Section 13. MCC is amended as follows: EMS PROGRAM OFFICE; ADMINISTRATION. (B) The responsibilities in division (A) of this section may be accomplished through the promulgation of administrative rules by the administrator, in accordance with the county's administrative rule process. All such rules that pertain to patient care, EM-TEMS Provider practice, ambulance equipment and supplies, and other medical matters shall be approved by the EMSMD prior to implementation. Section 14. MCC is amended as follows: SYSTEM QALITY MANAGEMENT AND IMPROEMENT. (A) All licenses are required as a condition of license, and all other EMS providers are encouraged, to participate in the quality management program for the EMS system. Participation includes: (1) Providing patient care data, dispatch and call determination data, EM-TProvider training and education information, vehicle maintenance information, E-MTstaff rosters, patient or other complaints, and other data and information determined by MCEMS to be necessary for the quality management process. This data is to be provided in a form and frequency to be determined by MCEMS; (B) All data, information, and proceedings associated with the quality management program that could identify patients, specific events, patient medical conditions, locations, or other possible identifiers shall be considered confidential and protected from discovery in accordance with ORS Chapter Section 15. MCC is amended as follows: EXCLSIE EMERGENCY AMBLANCE SERICE CONTRACT. (D) The contract shall have specific requirements that insure appropriate policies effecting the employees of the provider. These requirements include the following: Page 10 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

11 (1) A workforce diversity plan that meets or exceeds all federal, state, and local standards. The plan must include a specific process for the recruitment and retention of women and minority EMTsemployees; (2) Agreement to provide employment consideration and priority to paramedicsall Licensed EMS Providers displaced from employment with the providers in the county prior to the contract implementation to the extent that positions are available. From the time that an intent to reassign ambulance services is issued until six-months immediately following the date of replacement, the ambulance service must give preference to qualified, comparably-licensed employees of the previous ambulance service. Such hiring shall not require the persons hired to leave the employ of the ambulance service being replaced until the date the replacement service begins to provide ambulance services for the Multnomah County Ambulance Service Area; (3) Providing an employee assistance program (EAP) to all EMTsemployees. The EAP programs in force by the county and the City of Portland shall serve as the standard for evaluation of offered programs. Section 16. MCC is amended as follows: REASSIGNMENT. * * (B) At the end of the term of the initial contract, or at the end of any contract extension or renewal, the Board may exercise its option of renewing the contract or seeking a replacement provider. Section 17. MCC is amended as follows: CONTRACT COMPLIANCE AND RATE REGLATION COMMITTEE. (A) There shall be a Contract Compliance and Rate Regulation Committee (CCRRC), appointed by the Board, upon the recommendation of the County EMS Program Aadministrator. (B) The CCRRC shall be comprised of the following members: (C) The CCRRC will meet and review the response times and other performance requirements of the ambulance service contract and make recommendations to the EMS Administrator. The CCRRC will review all requests for rate adjustments and make recommendations to the EMS administrator. Page 11 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

12 (E) The CCRRC shall develop criteria to be used for rate adjustment decisions, to be approved by the Board. Section 18. MCC is amended as follows: RATE ADJSTMENT PROCEDRE. (B) The rate adjustment procedure is a contested hearings process with an appointed hearings officer that allows all interested, qualified parties to participate. The order of the hearing officer is forwarded to the CCRRC for final determination of the rates to be charged. Section 19. MCC is amended as follows: CCRRC RATE REIEW PROCEDRES. (A) The CCRRC shall schedule a review of the recommended order, which shall be held no more than 30 days after service of the recommended order. (B) CCRRC review of final recommended orders shall be confined to the record of the proceeding below, which shall include the following: (C) The CCRRC may allow oral or written argument by the parties. (D) Parties shall limit their argument to the CCRRC to issues regarding an error of law or fact in the order which is essential to the decision and which the party raised in exceptions filed under these rules. (E) officer. The CCRRC may affirm, reverse, remand, or modify the decision of the hearings (F) The CCRRC shall prepare a decision which shall include written findings of fact and conclusions, based upon the record. The CCRRC shall serve the decision upon all parties to the hearing. (G) nless appealed to the Board within the time specified, the decision of the CCRRC shall be final and nonappealable. Page 12 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

13 Section 20. MCC is amended as follows: APPEALS TO THE BOA. (A) Within ten days from the date a decision of the CCRRC is served, a party may file an appeal with the Board. (D) The Board may affirm, reverse, remand, or modify the decision of the CCRRC. Section 21. MCC is amended as follows: CCRRC CONTRACT COMPLIANCE REIEW PROCEDRES. (A) The CCRRC shall meet, at least annually, to review the performance, as specified in the contract, of the contractor for emergency ambulance service. (B) Data and information necessary for this review shall be provided by the contractor, BOEC, MCEMS, and others, as requested by the CCRRC. (C) The CCRRC will review the performance of the contractor and make recommendations to the EMS administrator as to the contract compliance of the contractor. Section 22. MCC is amended as follows: AMBLANCE DISPATCH. (B) Dispatch requirements and performance standards, medical triage systems or protocols, medical information requirements (pre-arrival instructions), and data requirements shall be specified in an intergovernmental agreement between BOEC and the County. The medical protocols and medical information requirements specified in that agreement shall be promulgated by the EMSMD. (D) All licensees receiving requests for ambulance services through their business telephone or by any other means other than BOEC, shall, using the a triage gtiklesystem that is approved by MCEMS and aligned with the system employed at BOEC, determine if the call meets the emergency dispatch requirements. If the call meets these requirements, that call information is to be transferred to 911 for dispatch. Licensees are prohibited from dispatching an ambulance to a call that meets emergency dispatch criteria. Page 13 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

14 Section 23. MCC is amended as follows: COMMNICATIONS. (B) All ambulances will be equipped, at a minimum, with a radio that allows communication with their dispatch center, Medical Resource Hospital MRH, and the receiving hospitals. Section 24. MCC is amended as follows: HOSPITAL AAILABILITY; AMBLANCE DIERSION. (A) Information regarding the ability of hospitals to receive ambulance transported patients shall be provided to ambulance units, by BOEC, using the CHORALHOSCAP system. (1) Each receiving hospital wishing to change its receiving status from time to time shall be equipped with the necessary computer and other requirements for participation in the CHORALHOSCAP system. Hospitals not participating in the CHORALHOSCAP system shall be considered available for ambulance transports at all times. (2) Ambulance companies may have CHORALHOSCAP equipment for purposes of monitoring the system. The BOEC CHORALHOSCAP computer information shall be the official information for the CHORALHOSCAP system. (B) Ambulances may be diverted from an intended hospital destination based only on the information provided by the CHORALHOSCAP system. In the event of a failure of the CHORALHOSCAP system, other means of communication, as authorized by the administrator, may be used to convey the hospital status. Section 25. MCC is amended as follows: MASS CASALTY INCIDENTS (MCI). (A) The MCI plan, as attached to the Multnomah County EMS administrative rule-sfield Protocols shall serve as the guide for the response of first responders and ambulances and the care and transportation of persons, when the number of persons meets the criteria for implementation of the plan. This plan shall be reviewed from time to time by the EMSMD and modified when necessary to insure that current standards of care are being met. Page 14 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

15 Section 26. MCC is amended as follows: SPECIAL RESPONSES. (A) Emergency medical response to certain calls may require specialized equipment and specially trained personnel. These calls include, but are not limited to, hazardous material calls, search and rescue, extrication, trench, dive, and high angel rescue, and support for law enforcement response teams. These specialized responses are the responsibility of the fire first responders, and in the case of search and rescue, the Sheriff. These teams shall have a designated Liaison between the team and the EMS Program and EMSMD. The Liaison is responsible for meeting reporting requirements to County EMS Program and EMSMD to ensure continuity of EMS System performance. Section 26. The Ambulance Service Plan attached to this Ordinance is adopted. FIRST READING: November 10, 2016 SECOND READING and ADOPTION: December 8, 2016 BOA OF CONTY COMMISSIONERS FOR MLTNOMAH CONTY, OREGON Deborah Kafoury, Chair REIEWED: JENNY M. MADKOR, CONTY ATTORNEY FOR MLTNOMAH C NTY, 0 EGON By Bernade e D. Nunley, A ssi "ant County Attorne Page 15 of 15 - Amending MCC Chapter 21 Health Emergency Medical Services and Declaring an Emergency.

16 Health Department EMERGENCY MEDICAL SERICES October 28, AMBLANCE SERICE PLAN SMMARY Multnomah County adopted its current Ambulance Service Plan (ASP) in The current ASP has resulted in an integrated system of Emergency Medical Services (EMS). This system uses the coordinated efforts of multiple agencies in order to provide rapid response, and high quality pre-hospital care and ambulance transport. The system has grown steadily in sophistication and quality. All this supports the primary mission of the EMS system to provide for the efficient and effective provision of ambulance services to the people of Multnomah County. The County has a number of goals in updating its ASP. The updated plan seeks to build on the successes of the current system. So the Proposed Draft ASP retains the current system s key features a single ambulance service area (ASA), a single accountable ambulance provider, first response by fire agencies as a distinct added-value component, unified medical direction, and ambulance transport that is supported by user fees without explicit financial subsidies by local government. The County also seeks to take advantage of the opportunities presented by our current environment. The update ASP intends to enhance the system s efforts around quality improvement. This means adopting new technologies, and adapting proven methods and standards of care for use in our community. The updated ASP changes mean taking advantage of the opportunity presented by health care reform to create closer relationships with other health care providers for the benefit of the community. This requires that our ASP anticipates change, and build in pathways for the system to develop and evolve over time. 426 SW Stark Street, 7 th Floor Portland, OR (503) phone (503) fax Page 1 of 3

17 Health Department Finally, changes mean keeping an eye on equity - making sure that the services of the EMS system are accessible and acceptable to all people in the County. As discussed above, this 2016 updated ASP retains most of the fundamental features of the previous (1994) ASP. There are five areas of proposed change: 1. There shall be established a new Emergency Medical System Advisory Council to allow for expert review and recommendation of system improvements and innovations moving into the future. 2. The approach to medical call triage and dispatch will be enhanced. This will be a multi-year effort that will begin when the updated ASP goes into effect. The County intends to implement a priority dispatch system that is able to differentiate various types and levels of medical need, and support dispatch of responders appropriate to the need. This approach requires a number of activities and resources - e.g., implementing new data systems, adopting a new system for classifying calls ( determinant codes ), and enhancing quality improvement activities. 3. The contracted provider of ambulance services will be allowed to contract with fire agencies to provide a limited amount of services that may enhance the overall system. 4. The scope of Medical Direction has been clarified. This primarily reflects the successful approach of the current system. These changes in triage and dispatch set the stage for the two future system changes: 1. With successful implementation changes in triage and dispatch, there is a potential to change ambulance response times in the future - e.g., lengthening response times for non-critical medical calls. 2. Also, with changes in triage and dispatch, there is a potential to change ambulance staffing. This updated ASP includes a process for proposing and reviewing ambulance staffing in future years, should this be deemed necessary and/or desirable. The following summarizes the key features of the 2016 ASP: 1. Multnomah County will comprise a single Ambulance Service Area. 2. First response to medical calls will be provided by licensed EMS providers though fire departments and districts and potentially jurisdictions in the future. 3. Ground ambulance transport for medical calls will be provided by a single contracted ambulance provider agency licensed by the Division and chosen by the County through a competitive proposal process as required byapplicable laws, rules, and policies. 4. All other ambulance services (for example pre-arranged non-emergency transfers and inter-facility transfers) will be provided by ambulance services licensed by the Division using ambulances licensed and regulated by Multnomah County. 426 SW Stark Street, 7 th Floor Portland, OR (503) phone (503) fax Page 2 of 3

18 Health Department 5. Air ambulance services will be provided by Division-licensed helicopter and airplane provider agencies providing EMS care consistent with Multnomah County medical care standards. 6. Ambulances responding to medical calls will be staffed by two Paramedics. 7. Dispatch for all medical calls will be provided by the City of Portland, Bureau of Emergency Communications (BOEC) Dispatch will utilize a priority dispatch system that is able to differentiate various types and levels of medical need, and dispatch responders appropriate to the need. 8. Primary radio communications for medical calls will be on an 800 MHz system. Fire and ambulance responders will use Mobile Data Terminals (MDT) to receive dispatch instructions and carry out other communications with the BOEC dispatch computer. 9. Medical direction and supervision will be provided by an EMS Medical Director employed by the Multnomah County. 10. Multnomah County Health Department s EMS Program Office will administer the County s Ambulance Service Plan and coordinate the County EMS system. 11. The EMS Program Office will develop and maintain a data base for use in monitoring the performance of providers and the overall EMS system. Data sources will include but not be limited to records from dispatch, pre-hospital patient care, and hospital disposition. 12. The EMS system will use a Continuous Quality Improvement process to evaluate the quality of patient care and ensure progressive improvement in care. 13. The costs of emergency ambulance transport, the EMS Medical Director, and the EMS Program Office will be financed by fees charged to people receiving care through the medical response system. Some First Response costs (such as medical supplies and equipment), and other system improvements also may be financed through the above mentioned fees. 426 SW Stark Street, 7 th Floor Portland, OR (503) phone (503) fax Page 3 of 3

19 Attachment A

20 R NE 72ND AE NE 119TH ST HW Y NS 84 SE 82ND AE S MA S CL ACK A SH AF FO ST SW SW EN S RIDGE S SO T H S SPRAG E SW 65TH AE Y SW BOONES FERR S BRADLEY SW D T T NE BOONES FERRY 213 Y9 HW 99E WY Multnomah 211 Yamhill Clackamas Marion Polk S PPER HIGHLAND lalla River Mo Location Map MLINO S LONE ELDER HWY Washington S SPANGLER WY HWY 551 H LL S LOWER HIGHLAND Barlow H FE Hood River A DD W Yamhill Clackamas 224 S Skamania Clark S CARS NE ARNDT S BARLOW N COLLEGE ST Yamh ill Mario n SE 122ND AE SE 92ND AE SE CESAR E CHAEZ BLD YLO SW ROY ROGERS PA CIF IC HW Y SW HILLS B OR TA SW MRRAY BLD N SW CLARK HILL Yamhill Washington Y CREEK HW E AGL SE E 9W KLE NE A BBEY TIC Clackamas Marion Columbia SH W Y9 9E Dayton D Canby Cowlitz Yamhill River River dding 3 S Lafayette Estacada S H 19 Y2 W ER R W AT WIL S ON ILLE R D S HENRICI S Pu 2 The information on this map was derived from digital databases on Metro's GIS. Care was taken in the creation of this map. Metro cannot accept any responsibility for errors, omissions, or positional accuracy. There are no warranties, expressed or implied, including the warranty of merchantability or fitness for a particular purpose, accompanying this product. However, notification of any errors will be appreciated. OW NE RING S SP Willamette River TOON B S LELAND S M AT S NEW ERA ER ILL E 1 ± BEAERCREEK NE D Creek Oregon City e thy ND ILL LA ED SW S WI L Miles 0 SR S L LE L I ON DR Wilsonville RS M E HW SW ADANCE SCH E AA Abe rn AIN S HWY 9W 9 Y S FI T N Newberg B EL L TY OW S EADEN L LAL MO 99W L HIL N:\CounterMaps\NewCounterMapsMXDs\Automate\MXDs\Copy_of_GBCurrent.mxd PETES MONT AI N E Dundee SW RICKS LL FA E TT A ME R SD 224 S FORSYTHE MO SW Washington Clackamas NE BELL NE YA MH ILL-NEWBERG HWY Clackamas River AN S HATT WILL Yamhill C hehal e m Creek CREEK 99E SE KELSO ER D R RI Gladstone 205 N NYSIDE 212 SE E Tualatin D WOOD R Damascus 26 SE TILLSTROM SW BORLAND SW CHAPMAN NE NORTH ALLEY West Linn Rivergrove 99W Sherwood GER KR ER D BL Durham SW TALATIN SW TALA TIN SHER SW EDY SE Johnson City LIN King City 43 HWY T DR SW DRHAM ND E BLD OR H G OM O SO TH LO MC SE MON T AIN H Happy alley SE BORGES SE S RI SW Y HW Tigard ER IEN OR EF BE SW BE SW LEBEA Multnomah Clackamas Lake Oswego 217 R I 26 Johnson C reek SW BLL M ONTAI N Gresham D SW SCHOLLS SHERWOOD SE HOLGATE BLD Milwaukie 210 R RY ELL BL D 99E SW COLMBI SE LL HO C S R S FE SW SE POW TER SW 210 SW LAREL E OL SO H IC OR IST SE DIISION ST RS F ERR Y E E 26 SE WOODSTOCK BLD A SW ROOD BRI SW MLTNOMAH BLD SW 10 S W CAPITO L HW Y SW 17 0TH AE SW 185TH AE R RI E Beaverton EH WY TH O LF TE AT IN HILLSD AL T AL SW BEAERTON 26 ive r SE STARK ST SE FO S L BA SW 175TH A HILL SW E AK DP 43 yr SE 302ND AE KW ROO NE B RNE LL S TO N RMING W FA NYON CA Troutdale Wood illage NE GLISAN ST 405 nd SE 282ND AE WY SSB NW CO Y 10 SW Carlton NE 112TH AE 99E Sa SE S W IO WA HILL SW IN G R E LW OD O Y NE HEND 84 NE HALSEY ST Rivers and water bodies NE SANDY BLD NE LLEY HW AL KE SW RR JEN D KIN S E H I LL LAT IN A Fairview A RN W SW TILE FLAT SW S PR A Maywood Park R Arterial streets Slough NE PRESCOTT ST NE FREMONT ST Washougal WB H WY NE AIR P OR T WA Y SE BELMONT ST Tualatin River W E A SW J O HNSON SCHOOL SW DIXON MILL YH M PS ON Columb ia D SR-1 4 E BRNSIDE ST SW SW TA SW TONGE LN SW NGER SW LA NW TH NE CO LMBIA BL NE KILLINGSWORTH ST W BASELINE 8 DGE Gaston Y Hillsboro SW BLD KW Y SW GOLF LE 8 SW BLOOMING FERN HILL FE NE ST LL NW CORNE C ORSE 47 NE LO MBA RE E NG e ek ST D Cornelius Forest Grove SK WY O NP W EB H Camas SE D Y LI NW EERG REE D BL Y SR Portland N D D PK OO ILL AM ETT E HW A Y BL D rban growth boundary D SE AMISIGGER T NION ILLE ING NW SPR W OM BA EN IR ER SW 257 ES N Multnomah Washington KAIS E R HE R AER W 8 SE E ERG RE D NW C THAT e Cre k D airy E DR NW OR NW GE N R M ANTOW NW EERGREEN NW HORNECKER R D NL SS MEEK NW R Clar Mult k nom ah MCGILL LAK SE 242ND AE 47 C NW HW Y NW BL NE MARTIN LTHER KING JR BLD S NS ET L M BI A NE MARIN N INTERSTATE AE CITY NW S LI E N NW 185TH AE S NSA KA NW ROY PA NW NW HELETIA 99E N CO SE Columbia River NW D S HAING AS M NW NW JACK SO K 26 NW GREENILLE 5 EE 26 SE MILL PLAIN BL DR CR SH AD YB RO O K N SCHOOL W N MA RIN E NE 18TH ST ouga l iver R W a sh 6 N H ON EL EN S ST NW K 6 Banks E M ILL PLAIN BLD E EERGREEN BL D C RO NW Y R LE D NW WILSON RIER HW E FORT H PLA BLD IN MEE N W M C NA DA CEDAR CANYON NW HILL S Y S T E M September 2015 SE 222ND DR k ree NW M O N TAIN I N F O R M A T I O N NE 28TH ST HW EY LL ancouver NW G ales Cr Creek ridge SE 192ND AE NW D ORLAN D tb Bu r n SE 172ND AE C HA N GILLI Dairy Cre iry 26 or k Da ek L A N D S NE FO RTH PLAIN BLD NE ANDRESEN ND SLA IE I SA F ast F ork T NE 162ND AE NW E st We IN SA I rban Growth Boundary NE 76TH ST H JO NE E NE HA EL DELL AE Z A RE 30 NE 99TH ST NE 88TH ST NE HIGHW AY 99 D NE 117TH AE N W LOWER RIER RR O SH KE NW L A NW E ED RE L R E G I O N A L NE 212TH AE Columbia Multnomah pdated: 9/2015 S NGER Please recycle with mixed paper

21 Attachment B

22 Legend Cities CITY OF FAIRIEW CITY OF GRESHAM CITY OF LAKE OSWEGO IN L.O. CITY OF LAKE OSWEGO OT O CITY OF MAYWOOD PARK CITY OF MILWAKIE CITY OF PORTLAND CITY OF TROTDALE CITY OF WOOD ILLAGE Notes This map is provided for informational purposes only. Information used to develop this map has been obtained from many sources, and is not guaranteed to be accurate. Multnomah County assumes no responsibility for the accuracy of information appearing on this map. Scale: 1: 410,033 Printed: 2/23/2016

23 Legend Fire Districts CLACKAMAS FIRE DIST #1 JT CORBETT RRAL FIRE DIST #1 MLT CO FIRE DISTRICT #10 RIEALE FIRE DISTRICT #11 SAIE IS FIRE PROTECT DIST SCAPPOOSE FIRE DISTRICT #3 T FIRE/RESCE DIST #1 JT Notes This map is provided for informational purposes only. Information used to develop this map has been obtained from many sources, and is not guaranteed to be accurate. Multnomah County assumes no responsibility for the accuracy of information appearing on this map. Scale: 1: 410,033 Printed: 2/23/2016

24

25 Attachment C

26 Multnomah County - Class Specification Bulletin Page 1 of 2 2/26/2016 EMS Medical Director Class Code: 9530 MLTNOMAH CONTY Bargaining nit: Non nion SALARY RANGE $ $97.72 Hourly $5, $8, Semi-Monthly $10, $17, Monthly $127, $204, Annually DEFINITION: To provide medical supervision for all emergency medical technicians providing pre-hospital patient care within the County, and to provide medical direction to all components of the emergency medical services system. EXAMPLES OF DTIES: ESSENTIAL FNCTIONS (Essential functions, as defined under the Americans with Disabilities Act, may include the following duties and responsibilities, knowledge, skills and other characteristics. Depending upon assignment, the incumbent may perform a combination of some or all of the following duties, which are a representative sample of the level of work appropriate to this classification.) Develop uniform standards of emergency care within the County; solicit input regarding standards from physicians, nurses, emergency medical technicians, ambulance providers, first responder providers, hospitals, government agencies, and other interested organizations and individuals. Accompany emergency medical technicians during the performance of medical duties for the purpose of supervision, education, and system evaluation. Promulgate and revise, as necessary, medical care standards for: priority dispatch/pre-arrival instructions; ALS and BLS patient care protocols; hospital destination criteria; accreditation requirements for pre-hospital care personnel beyond State standards; staffing, equipment, supplies, and operational criteria for first response vehicles, ground ambulances, air ambulances, specialized critical care and mobile intensive care ambulances, and non-emergency patient transport vehicles for incorporation into licensing requirements; response times for first responders and transporting emergency ambulances; the transferring of patients between hospitals; and the provision of medical services in areas of public assembly. Set standards for the provision of on-line medical control; develop and supervise a quality management program to ensure continuous improvement of all levels of care within the emergency medical services delivery systems; set standards and objectives, and participate in the continuing education and training of pre-hospital care personnel. Approve emergency medical technicians for practice in the County. Establish policies and due process for the limiting of practice of emergency medical technicians, including probation, suspension, or revocation of physician orders. Perform related duties as assigned. SPERISION RECEIED AND EXERCISED: Receives administrative direction from the Director, Health Department. Exercises technical supervision over emergency medical technicians. KNOWLEDGE/SKILLS/ABILITIES REQIRED: Principles, practices, and procedures of emergency medicine. Principles, practices, and procedures of pre-hospital patient care. Principles, practices, and procedures of public health. Federal, state, and local laws and regulations governing the practice of emergency medicine and pre-hospital emergency medical services. Principles of supervision, training, and performance evaluation. Effectively administer a variety of emergency medical care activities. Interpret and apply applicable federal, state, and local laws, rules, regulations, and policies governing emergency medical services.

27 Multnomah County - Class Specification Bulletin Page 2 of 2 2/26/2016 Establish and maintain cooperative working relationships with those contacted in the course of work. Communicate clearly and concisely, both orally and in writing. Gain cooperation through discussion and persuasion. Supervise, train, and evaluate assigned staff. MINIMM QALIFICATIONS REQIRED FOR ENTRY: Any combination of experience and training that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be: Education/Training: Graduation from an accredited medical school and completion of an emergency medicine residency, AND Experience: Three years of increasingly responsible emergency medical services experience, including system medical direction and emergency medical technician supervision. License or Certificate: Possession of, or ability to obtain, an appropriate and valid license to practice medicine in the State of Oregon. Board certification in emergency medicine. Depending upon assignment, candidates may be required to pass a criminal background check. CLASSIFICATION TYPE/FLSA/HISTORY: Type: nclassified Executive FLSA: Exempt History: March 13, Added criminal background check verbiage. PSG: 236

28 MLTNOMAH CONTY AMBLANCE SERICE PLAN 2016 Multnomah County Ambulance Service Plan 2016 Page 1 of 41

29 Table of Contents: SECTION Page 1. CERTIFICATION BY GOERNING BODY OF CONTY AMBLANCE SERICE PLAN 5 2. OERIEW OF CONTY (DEMOGRAPHIC AND GEOGRAPHIC DESCRIPTION) 6 3. DEFINITIONS 8 4. BONDARIES 13 (a) ASA Map(s) with Response Time Zones Attachment A (b) ASA Narrative Description 13 (c) Map(s) Depicting "9-1-1", Fire Districts and Incorporated Cities Attachment B (d) Alternatives Considered to Reduce Response Times SYSTEM ELEMENTS 15 (a) Dispatched Calls 15 (b) Pre-arranged Non-emergency Transfers and Inter-facility Transfers 16 (c) Notification and Response Times 16 (d) Level of Care 19 (e) Personnel 20 (f) Medical Supervision 23 Multnomah County Ambulance Service Plan 2016 Page 2 of 41

30 (g) Patient Care Equipment 25 (h) ehicles 26 (i) Training and Education 26 (j) Quality Improvement 27 (A) Structure 27 (B) Process and Problem Resolution 28 (C) Sanctions for Non Compliant Personnel or Providers ADMINISTRATION AND COOINATION 29 (a) The Entity That Shall Administer and Revise the ASA Plan 29 (b) Complaint Review Process 31 (c) Mutual Aid Agreements 32 (d) Disaster Response 32 (A) County Resources Other Than Ambulances 32 (B) Out of County Resources 33 (C) Mass-Casualty Incident Plan 33 (D) Response to Terrorism and Disasters 33 (e) Personnel and Equipment Resources 34 (A) Non-transporting EMS Provider 34 Multnomah County Ambulance Service Plan 2016 Page 3 of 41

31 (B) Hazardous Materials 34 (C) Search and Rescue 35 (D) Specialized Rescue 35 (E) Extrication 35 (f) Emergency Communication and System Access 36 (A) Telephone 36 (B) Dispatch Procedures 36 (C) Radio System 37 (D) Emergency Medical Dispatcher (EMD) Training PROIDER SELECTION AND EALATION 38 (a) Initial Assignment 38 (b) Reassignment 39 (c) Application for an ASA 40 (d) Notification of acating an ASA 40 (e) Maintenance of Level of Service CONTY OINANCES AND RLES 41 Multnomah County Ambulance Service Plan 2016 Page 4 of 41

32 1. CERTIFICATION BY GOERNING BODY OF CONTY AMBLANCE SERICE PLAN CERTIFICATION OF THE MLTNOMAH CONTY AMBLANCE SERICE PLAN The undersigned certify that pursuant to Oregon Administrative Rules through that: Each ambulance service plan element contained in these rules has been addressed and considered in the adoption of this plan by the Board of County Commissioners, and In the Board's judgment, the ambulance service area established in the plan provides for the efficient and effective provision of ambulance services, and To the extent they are applicable, the County has complied with ORS , , and , and with existing local ordinances and rules. Dated at Multnomah County,. Reviewed: Deborah Kafoury Chair, County Board of Commissioners Bernadette D. Nunley Assistant County Attorney Multnomah County Ambulance Service Plan 2016 Page 5 of 41

33 2. OERIEW OF CONTY (DEMOGRAPHIC AND GEOGRAPHIC DESCRIPTION) Geography Multnomah County has the highest population of all Oregon counties, and is the most densely populated county in Oregon. The population is predominantly urban; 97% of the population resides within the urban growth boundary established by Metro. The County extends from the junction of the Willamette and Columbia Rivers on the West to the foothills of the Cascade Mountains on the East. The County covers 465 square miles. Multnomah County is characterized by significant variations in terrain and transportation networks, both in urban and in non-urban areas. Hills, winding roads and traffic congestion present emergency response challenges in themselves. These challenges can be compounded by the effects of weather such as snow and ice, and landslides. Multnomah County also has large areas that are agricultural, forested, or other types of open space. Some of these areas have barriers to access by emergency vehicles, so special response resources may be needed. While they are hard to reach, there are few calls for emergency medical services in these areas. Population 2015 S Census Bureau data shows the following: Jurisdiction Population Percent of County City of Portland 632, City of Gresham 110, City of Troutdale 16, City of Wood illage 4, Multnomah County Ambulance Service Plan 2016 Page 6 of 41

34 City of Fairview 9, City of Maywood Park nincorporated Areas (by subtraction) 16, Total Multnomah County 790, In addition to the population living in Multnomah County, there is a significant net influx of people that occurs during the day, increasing the population by roughly 16% Emergency Medical Resources There are a number of organizations within Multnomah County currently providing emergency medical services. City fire departments and rural fire protection districts currently provide first response services for the entire county. Each fire department or district determines deployment patterns necessary to provide emergency responses for fires, rescue situations, and medical calls. These deployment patterns are based on each community s needs, and operational and financial priorities and constraints. Fire departments and districts respond on most medical calls including time-critical calls, and all calls that require specialty rescue, extrication, or non-medical technical response. Currently, the two city fire departments provide a mix of BLS and ALS first response. There are five fire districts that currently provide service primarily at the BLS level. The scope and intensity of medical services provided by fire departments and districts evolve over time. One contracted (franchised) private ambulance company provides response and ambulance transport for all medical calls. This company provides non-emergency services as well. Three other private companies provide non ambulance service. All ambulance provider agencies are licensed by the Division and regulated by Multnomah County EMS. Multnomah County Ambulance Service Plan 2016 Page 7 of 41