EMERGENCY MEDICAL SERVICES COMMITTEE

Transcription

1 County of Santa Clara Public Health Department Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San José, CA voice fax EMERGENCY MEDICAL SERVICES COMMITTEE Chair: Health Advisory Commissioner Harry Hall Thursday, October 6, :00 pm 3:00 pm (Voting Members Requested to RSVP by September 29, 2011) Santa Clara County Sheriffs 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. Consent Calendar (Commissioner Hall) Consent matters include routine committee and administrative actions, and are approved by a single majority vote. Any Committee Member may remove an item from the consent calendar for further discussion or consideration. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V. Smith 1

2 4. Approval of June 2, 2011 Meeting Minutes. 5. Summary of Approved or Pending Board of Supervisors and Health & Hospital Committee Items A. May 10, Board of Supervisors Proclamation Declaring May 15-21, 2011 as "Emergency Medical Services Week" Including the Designation of May 18th as "Emergency Medical Services for Children Day" B. June 3, Health and Hospital Committee Quarterly 911 Ambulance System Report for the Santa Clara County Exclusive Operating Area. C. June 7, Board of Supervisors Private (Non-911) Ambulance Service Agreements D. June 7, Board of Supervisors First Amendment to Contract with Rural/Metro for 911 Emergency Ambulance Services E. June 21, Board of Supervisors Various Actions Related to Agreement with National Association of County and City Health Officials (NACCHO) for Medical Reserve Corps Unit (Santa Clara County Medical Volunteers for Disaster Response) F. June 21, Board of Supervisors 2010 Santa Clara County Emergency Medical Services Plan G. June 21, Board of Supervisors Second Amendment to Contract with Rural/Metro for 911 Emergency Ambulance Services H. August 10, Health and Hospital Committee Quarterly 911 Ambulance System Report for the Santa Clara County Exclusive Operating Area. 6. EMS Committee Stakeholder Meeting Minutes A. Prehospital Providers Advisory Committee B. Medical Advisory Committee Regular Calendar Regular Calendar 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. 7. Membership (Commissioner Hall) A. Approve New Members I. Ken Kehmna nominated to replace Roger Bloom as the representative of the County Fire Chiefs Association. 2

3 8. EMS System Update (Staff) A. EMS Agency Strategic Planning (Petrie) B. EMS System Strategic Planning (Petrie) C EMS Conference (Davies) D. 911 EMS Receiving Hospital Agreements (Petrie) E. EMS Awards Program (Petrie) Request approval to execute a Santa Clara County EMS Awards program to be presented at the Annual EMS Conference. 9. Medical Director Verbal Report (Rudnick) 10. EMS Trust Fund (Davies) ( ) A. Accept Report - Trust Fund Balance/Status of Projects i. Request Approval to Convene the EMS Trust Fund Advisory Group for the purpose of reviewing funding proposals 11. Exclusive Operating Area Contract Status (Davies) A. County EOA Update i. Accept Rural/Metro Response Time Performance Reports for July and August 2011 ( ) ii. Accept Fire Department Response Time Performance Verbal Report B. Palo Alto EOA Update Accept Verbal Report 12. Member Roundtable and Reports 13. Good of the Order (Commissioner Hall) Presentation of other applicable information that is not on the Agenda and that does not require Committee action. 14. Next Meeting and Adjourn (Commissioner Hall) December 1, 2011 from 1-3 pm at the Sheriffs Department Auditorium Venue and Parking Instructions Visitor parking is available in the County building designated Visitor areas. No food or uncapped beverages are permitted in the training room. This meeting will be recorded. 3

4 County of Santa Clara Public Health Department Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San José, CA voice fax EMERGENCY MEDICAL SERVICES COMMITTEE Meeting Minutes Thursday, June 2, 2011 Santa Clara County Sheriff s Department Auditorium 55 West Younger Avenue, San Jose, CA :00 3:00 pm MEMBERS PRESENT Harry Hall, Chair, Commissioner, appointed by the Health Advisory Commission Roger Bloom, Manager member of an entity providing fire protection and prevention services nominated by Santa Clara County Fire Chief s Association Jose Chavez, Public Safety Sector Paramedic knowledgeable in local emergency medical services nominated by the Santa Clara County Fire Chief s Association Jo Coffaro, Executive nominated by Hospital Council of Northern California Steven Drewniany, Management member of an entity providing police protection nominated by Santa Clara County Police Chief s Association Randy Hooks, Management member of a permitted noncontract ambulance provider nominated on a rotating basis by the EMS Administrator Rick Kline, Physician, whose primary practice is trauma medicine (appointed by the Santa Clara County Trauma Audit Committee) Travis Kusman, Management member of the permitted exclusive operating area contracted emergency ambulance service provider nominated by contracted emergency ambulance service provider) Elaine Nelson, Practicing Physician whose primary practice is emergency medicine(nominated by the SBMEDA (South Bay Emergency Medical Directors Association) James Silva, Practicing physician & surgeon whose practice is primarily pediatrics nominated by the Santa Clara County Medical Association Jennifer Sparacino, Executive nominated by the County City/County Managers Association MEMBERS ABSENT Jordan Eldridge, Commissioner (appointed by the Health Advisory Commission) Adrian Ayllon, Private Provider Field EMT/Paramedic nominated by the Prehospital Providers Committee Joshua Freilich, Registered Nurse, knowledgeable in local emergency medical services nominated by Emergency Nurses Association Jennifer Woodfall, Registered Nurse, knowledgeable in local trauma services nominated by the Santa Clara Trauma Program Managers OTHERS PRESENT Jeff Dane, AMR STAFF PRESENT Per Schenck, Interim EMS Director Erick Rudnick, EMS Medical Director Josh Davies, EMS Section Manager Lilia Felix-Villalobos, EMS Executive Assistant John Blain, EMS Specialist - Compliance. STAFF ABSENT Patricia Natividad, Management Analyst Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V. Smith 4

5 1. Call to Order / Roll Call Harry Hall called the meeting to order at 1:05pm. Quorum reached with majority of members present. 2. Introductions and Announcements Harry Hall welcomed everyone and asked for introductions. Josh Davies introduced Per Schenck as Interim EMS Director. He also introduced Travis Kusman, General Manager for Rural/Metro Ambulance. Per Schenck announced that the Michael Petrie has been selected as the new EMS Director replacing Tom Lynch. His start date is July 5, Public Comment Period There were no comments. Consent Calendar (Commissioner Hall) 4. Approval of Meeting Minutes for October 7, 2010 and March 3, Summary of Approved or Pending Board of Supervisors and Health & Hospital Committee Items A. October 26, Board of Supervisors Continuation of Trauma Center Designation with Regional Medical Center of San Jose. B. November 10, Health and Hospital Committee Annual Report on the Status of the Santa Clara County Trauma System. C. November 23, Board of Supervisors California Emergency Medical Services Information Systems Grant Award. D. January 25, Board of Supervisors - Salary Ordinance Amendment Adding 3.0 Emergency Medical Services Specialist Positions in the Emergency Medical Services Agency Related to the 911 Ambulance Exclusive Operating Area Agreement. E. January 25, Board of Supervisors - Various Actions Related to the California Emergency Medical Services Authority Regional Disaster Medical and Health Program. F. April 5, Board of Supervisors Resolution Delegation Authority to Execute Emergency Medical Services Provider Agreements with Santa Clara County fire Departments/ Districts. G. April 13, Health and Hospital Committee 911 County Executive for Area (EOA) Ambulance Contract Response Time Compliance for American Medical Response and Fire Departments. H. April 13, Health and Hospital Committee Annual Report on the Status of the Emergency Medical Services Trust Fund. I. April 13, Health and Hospital Committee Annual Review of the Supplemental Transport Ambulance Resources (STAR) Program. J. April 13, Health and Hospital Committee Quarterly 911 Ambulance System Report for the Santa Clara County Exclusive Operating Area. 6. EMS Committee Stakeholder Meeting Minutes A. Prehospital Providers Advisory Committee B. Medical Advisory Committee 7. EMS Committee Bylaws A. Included for the benefit of new members. No changes have been made. Changes require authorization from the Health Advisory Commission Stakeholder Meeting Schedule Posted to Included for the benefit of new members. Consent Calendar Items 4-8 were approved. Vote: Unanimous Motion: J. Cofarro Second: R. Kline Abstain: None 5

6 Regular Calendar 9. Membership (Commissioner Hall) A. Accept and Approve New Member Nominations I. Jo Coffaro nominated to replace Michael Hutchinson as the representative of the Hospital Council of Northern CA II. Michelle Woodfall nominated to replace Wendy Hums as the representative of Santa Clara Trauma Center and Trauma Audit Committee III. Roger Bloom will serve as temporary representative of Santa Clara County Fire Chief s Association IV. Travis Kusman nominated (Rural/Metro) to replace Gil Glass as representative of the County 911 Ambulance Provider Josh Davies announced new members nominated at previous meeting held on March 3, New member nominations accepted and approved. Vote: Unanimous. Motion: S. Drewniany Second: E. Nelson Abstain: None 10. EMS System Update (Davies) A. County EOA RFP Update I. Rural/Metro Implementation II. Fire Department/county Agreements III. Private Ambulance Services Agreements IV. EMS System Work Plan Updates Josh Davies reported: 1) County EOA RFP timelines for new contract implementation with Rural Metro Ambulance. AMR and Rural Metro continue to work closely through the transition period. AMR has experienced staffing shortages. As a result AMR has been issued a first potential breech which will be verified through the Exemption Review Committee. 2) Most of the agreements with the fire departments are moving forward through their processes. The only exceptions are agreements with the NASA Ames and City of Palo Alto. All 8 private ambulance agreements for Non-911 services have also been processed and will go to board of supervisors on June 21. 3) The EMS Systems Work Plan is updated monthly and is posted to the EMS Agency website. 11. Medical Director Verbal Report (Rudnick) Eric Rudnick updated on Quality Clinical Care Management. Dr. Rudnick reported 1) Participated with Rural Metro in hire of medical advisor Heather Tagger. 2) The Medical Advisory Committee timeline for proposed clinical protocols changes and workshops planned to prepare Emergency Department for changes to come. 3) The implementation of Tourniquet use. 12. EMS Trust Fund (Davies) A. Trust Fund Balance/Status of FY11 Projects B. Trust Fund Budget and Spending Plan I. April 13, Health and Hospital Committee Annual Report on the Status of the Emergency Medical Services Trust Fund. C. Approve Revisions to EMS Trust Fund Application. Josh Davies reported on Trust Fund Balance/Status of FYII Projects. After brief discussion and members comments, modified Revisions to EMS Trust Fund Application were approved. Item 12C approved. Motion: J. Sparacino Second: R. Kline Abstain: None D. Approve Trust Fund Project Solicitation Josh Davies requested approval to open solicitation for funding for this year. Item 12D. Approved. Motion: J. Coffaro Second: S. Drewniany Abstain: None 6

7 13. Exclusive Operating Area Contract Status (Davies) A. County EOA Update - AMR Response Time Performance B. Palo Alto EOA Update C. Presentation: 911 Ambulance Agreement with Rural/Metro D. Rural/Metro Open House Josh Davies reported on performance response time. AMR continues to perform well. The City of Palo Alto has been working with the County for the Rural Metro contract implementation. Roger Bloom reported that the City of Palo plans to enhance system in order to lower response time and increase call capture. Josh Davies presented an update on 911 Ambulance Agreement with Rural/Metro. He announced that the Rural/ Metro Open House scheduled for Friday, June 24, 2011 at11am-4pm. 14. Member Roundtable and Reports None reported. 15. Good of the Order (Commissioner Hall) None reported. 16. Next Meeting and Adjourn at 2:27pm (Commissioner Hall) October 6, 2011 from 1-3 pm at the Sheriffs Department Auditorium 7

8 BOS Agenda Date :May 10, 2011 County of Santa Clara Public Health Department PH DATE: May 10, 2011 Prepared by:. Josh Davies EMS Section Manager Reviewed by:. Per Schenck Interim EMS Director TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public Health Director SUBJECT: Proclamation Declaring May 15-21, 2011 as "Emergency Medical Services Week" Including the Designation of May 18th as "Emergency Medical Services for Children Day" RECOMMENDED ACTION Adopt and Present Resolution proclaiming May 15-21, 2011 as "Emergency Medical Services Week" including the designation of May 18, 2011 as "Emergency Medical Services for Children Day" in Santa Clara County. (Public Health Department) (Roll Call Vote) FISCAL IMPLICATIONS There is no impact on the General Fund as a result of this action. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 8 Liz Kniss County Executive: Jeffrey V. Smith 1

9 BOS Agenda Date :May 10, 2011 REASONS FOR RECOMMENDATION Proclaiming May 15-21, 2011 as "Emergency Medical Services Week" including the designation of May 18th as "Emergency Medical Services for Children Day" in Santa Clara County will serve as a community-wide catalyst to join together and recognize the many dedicated emergency medical personnel from both public and private sectors. This year's theme, "Everyday Heros", focuses on the commitment and dedication of Paramedics, Emergency Medical Technicians (EMTs), Emergency Department Personnel, Firefighters, and Law Enforcement Officers that comprise our local Emergency Medical Services (EMS) system. BACKGROUND Each year, the American College of Emergency Physicians, the Governor of the State of California, and the President of the United States have declared the third week of May to be "Emergency Medical Services Week." This national celebration provides an opportunity to honor the work of our local EMS personnel and recognize the positive impact on the health and well being of the people of Santa Clara County. Over thirty years ago, President Gerald Ford signed the first EMS Week Proclamation recognizing the lifesaving contributions that EMS makes in our communities. Since that time, EMS has evolved considerably, including enhanced professional training, improved communications and technology, standardized licensure, and the development of successful public education and injury prevention programs. EMS for Children's vision for the future is a seamless system of care that works perfectly for all children but is used less frequently as both injury and illness prevention reduce the number of children facing life-threatening emergencies. The challenge facing health care professionals today is to ensure that this vision becomes a reality. In Santa Clara County, over 40 public agencies and 20 private companies contribute to the success of the EMS System. EMS providers county-wide answer the community's call to nearly 100,000 emergency medical service requests per year, and provide vital prehospital patient care and transportation services to the residents and visitors of Santa Clara County. CONSEQUENCES OF NEGATIVE ACTION Failure to proclaim May 15-21, 2011 as "Emergency Medical Services Week" including the designation of May 18th as "Emergency Medical Services for Children Day" will result in a Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 9 Liz Kniss County Executive: Jeffrey V. Smith 2

10 BOS Agenda Date :May 10, 2011 lost opportunity to recognize the many contributions made by Emergency Medical Services professionals and volunteers throughout the County. ATTACHMENTS EMS Week 2011 Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 10 Liz Kniss County Executive: Jeffrey V. Smith 3

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13 Committee Agenda Date :June 3, 2011 County of Santa Clara Public Health Department Emergency Medical Services PH DATE: June 3, 2011 Prepared by:. Josh Davies EMS Section Manager Reviewed by:. Per Schenck Interim EMS Director TO: Supervisor.Liz.Kniss, Chairperson Supervisor.Ken.Yeager, Vice Chair Health & Hospital Committee FROM: Dan Peddycord, RN, MPA/HA Public Health Director Dan Peddycord, RN, MPA/HA Public Health Administrator SUBJECT: 911 Ambulance System Report for the Santa Clara County Exclusive Operating Area RECOMMENDED ACTION Accept report from the Emergency Medical Services (EMS) Agency regarding the status of implementation of the agreement with Rural/Metro of California. FISCAL IMPLICATIONS Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 13 Liz Kniss County Executive: Jeffrey V. Smith 1

14 Committee Agenda Date :June 3, 2011 The County General Fund is not adversely impacted by this service agreement. CONTRACT HISTORY On December 14, 2010 the Board of Supervisors approved a (5) five year service agreement with Rural/Metro of California. Rural/Metro is a new ambulance service provider in the County and will replace American Medical Response (AMR) effective July 1, 2011 as the County Exclusive Operating Area 911 ambulance and paramedic service provider (excluding the City of Palo Alto and Stanford Land Parcels). The service agreement with Rural/Metro permits up to (2) two, (3) three year extensions by the Board of Supervisors. REASONS FOR RECOMMENDATION At the December 14, 2010 Board of Supervisor Meeting; Supervisor Kniss requested regular updates be provided to the Health and Hospital Committee as to the performance of the newly selected County Exclusive Operating Area Ambulance Provider, Rural/Metro. The first of those reports occurred on April 13, At this meeting, Supervisor Yeager requested an additional pre-contract implementation update be added in June Supervisor Yeager requested that information related to the public information/media plan be included in this report. The media/puplic informaton plan is attached as an addendum to this report. BACKGROUND. Media/Public Information Plan: The County has been informed by Rural Metro that they have been actively working with local media in the form of print, radio and television to prepare messaging regarding the transition of Ambulance Service Providers. It is our understanding that messaging will. initiate in earnest by mid June, with a major event planned for June 24th. An outline of Rural Metro's media plan is atttached to this report for reference. It is our understanding the Rural Metro, media spokesperson, Michael Simonsen will be available at the Health and Hospital Commitee meeting on June 3rd to address any questions... General Process Activities Related to the Transition: The County is in the process of completing agreements with County fire departments. related to their provision of first response emergency medical services. The Board. approved delegation of authority for these agreements in May Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 14 Liz Kniss County Executive: Jeffrey V. Smith 2

15 Committee Agenda Date :June 3, The County is in the process of making two amendments to the Agreement between the. County and Rural/Metro. The first is the addition of a data sharing agreement exhibit; the. second provides clarifying details of the "lock box" security... The EMS Agency and Rural/Metro continue to work together on a daily basis to implement.. the provisions of the agreement for services in preparation for the July 1, 2011 start date... The EMS Agency has hired two of the three FTE required to monitor the agreement with.. Rural/Metro and the fire departments... A quarterly EMS Field Personnel "Town Hall" meetings is scheduled for May 17th. This. meeting provides an forum for field paramedics and EMTs to interact with the. EMS Agency, discuss areas of concern, and offer suggestions for system improvement... The operational plan for the June 30/July 1 AMR to Rural/Metro transition is well under development. It is likely that the actual transition will occur over a several hour period consistent with a low-call volume between June 30th and the early morning hours of July 1, Both Rural/Metro and AMR have committed to increased staffing during this. transition period to assure for maintenance of the integrity and quality of our EMS System. In addition, the EMS Agency will be requesting support from the other permitted ambulance services should an unexpected EMS System surge event occur... On April 13th at the Health and Hospital Committee Meeting, Supervisor Yeager requested. information related to Rural/Metro's media and public education effort. A report from. Rural/Metro has been attached that addresses the areas requested.... American Medical Response Transition Activities... AMR has been responsive to the EMS Agency and Rural/Metro during the this transition. phase. AMR is a participant on the transition team and has agreed to assist the County and. Rural/Metro with planning and logistics of the transition itself... The EMS Agency is supporting AMR's transition to a permitted private ambulance service. provider that will continue to perform non-emergency/interfacility-transfers in accordance with the County Ordinance Code. Credentialing of personnel and the service are in Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 15 Liz Kniss County Executive: Jeffrey V. Smith 3

16 Committee Agenda Date :June 3, 2011 progress... The EMS Agency is monitoring to assure compliance with response time standards throughout the term of the current agreement. Should AMR fail to meet response time.. compliance, the County has the ability to implement Lame Duck securities contained in the existing agreement between the County and AMR.... Rural/Metro Transition Activities... The Santa Clara County Rural/Metro website is on-line at Updates continue to be provided every Monday on the website. Eligible incumbent personnel began training with Rural/Metro in the week of May 9th. All training is paid by Rural/Metro and is scheduled on rotating schedules so that all employees can attend the five, nine hour transition modules prior to June 30th. Rural/Metro hosted two workforce mixers for future incumbent Paramedics and EMTs. The initial rounds of EMS Field Supervisor interviews have been completed. The EMS Agency and Santa Clara County Fire Chiefs Association have been participating on the interview panels. A second round of interviews is scheduled for May 17th. Five of the nine EMS Field Supervisors have been selected (all are current AMR personnel). A total of 30 ambulances have arrived, which includes 2 bariatric ambulances. Rural/Metro expects a total of at least 52 by late May. Seven of nine EMS Supervisor Vehicles have arrived. A fleet maintenance truck and disaster response unit have arrived on site. Call data/deployment servers have been installed. All radio equipment has arrived and is currently being programmed by County Communications. Radios and headsets are currently being installed in all the ambulances. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 16 Liz Kniss County Executive: Jeffrey V. Smith 4

17 Committee Agenda Date :June 3, 2011 The supply center is currently under construction and should be completed by mid or late may. Rural/Metro and AMR continue to coordinate various transition activities. The Tap Chart Patient Care Reporting System has been presented to the hospitals and will be presented to the specialty centers in May. This system enables the transmission of patient care data from the field to the hospital. Rural/Metro, County EMS and Philips have collaboratively met with representatives of the Santa Clara County STEMI receiving facilities and initiated the implementation of the 12 Lead EKG transmission program. Rural/Metro is scheduled to meet with local ER staff to discuss Tap Chart. All Mobile Data Computers (MDCs) have arrived and are being programmed. The network circuits are now functional between Rural/Metro and County Communications and Rural/Metro and Corporate Rural/Metro. Rural/Metro has completed meetings with all fire departments to discuss station housing and other services for hire/exchange. Final section of ambulance housing locations is scheduled to occur by mid May. Rural/Metro continues to establish agreements with local vendors for services such as fleet services, furniture, facility maintenance, etc. EMS Communications System modifications are in progress including radio channel assignments, vehicle location programs, system status management software installation, surveillance technologies, etc. FirstWatch electronic data reporting system installation is progressing. Dashboard will enable hospitals to view pending ambulance arrivals and chief complaint, identify illness/injury trends, and assist in assessment of response time performance reporting. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 17 Liz Kniss County Executive: Jeffrey V. Smith 5

18 Committee Agenda Date :June 3, 2011 CONSEQUENCES OF NEGATIVE ACTION The Health and Hospital Committee will not receive the information requested from the EMS Agency. ATTACHMENTS Rural/Metro Media Plan for Implementation Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 18 Liz Kniss County Executive: Jeffrey V. Smith 6

19 Rural/Metro Santa Clara Community & Media Outreach Plan Overview Rural/Metro s contract for Ambulance Service was confirmed on December 14, 2010 by the Santa Clara Board of Supervisors. The contract begins on July 1, 2011 for a period of 5 years with two 3 year extensions. Rural/Metro was awarded the contract over the 30 year incumbent provider. Rural/Metro has begun to implement an aggressive communication, education and outreach program to build and/or strengthen relationships and educate the public about the change in the EMS service provider. Goals and Objectives 1. Communicate a clear, convincing and compelling messages that will educate the community on the change in EMS providers and emphasize the system/service enhancements that will be implemented as a result Rural/Metro being selected as the EMS provider for Santa Clara County 2. Generate news and editorial coverage that will educate County residents and other stakeholders on the change in service providers and system enhancements. 3. Build a broad, dynamic coalition of supporters that reflect the diverse interests of Santa Clara County 4. Keep elected officials and key staff updated on key Rural/Metro initiatives and service delivery Action Plan 1. Develop a sound, credible, consistent and supportable message 2. Create appropriate collateral information consisting of, but not limited to, website, Introduction letter, Fact Sheet, FAQ s, Company Profile, Key Management Bio s, SCC specific brochure etc. 3. Identify key third party opinion leaders, organizations, and institutions for presentations and briefing sessions. 4. Develop outreach schedule 5. Brief elected officials and staff in Santa Clara County 6. Build Rural/Metro website 7. Develop database of contacts 8. Develop community presentation, which could include video, ppt., speakers bureau 9. Join business and trade associations 10. Participate in community fairs, and civic events 11. Identify and create partnerships with key charitable organizations and non profits 12. Develop media contact protocol and local media crisis protocol 13. Schedule editorial board meetings with targeted newspapers 14. Develop feature stories 19

20 Rural/Metro Open House/Ribbon Cutting In addition to our community outreach efforts, Rural/Metro will use the Open House/Ribbon Cutting at our Operations Center on Friday, June 24 as the catalyst to generate wide media attention about the change in the EMS provider. We will be meeting and prepping various TV and print news outlets as we lead up to the change in service. To date we have already met with The San Jose Mercury News, Silicon Valley/San Jose Business Journal, and Gilroy Dispatch. 20

21 BOS Agenda Date :June 7, 2011 County of Santa Clara Public Health Department Emergency Medical Services PH DATE: June 7, 2011 Prepared by:. Josh Davies EMS Section Manager Reviewed by:. Per Schenck Interim EMS Director TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public Health Administrator SUBJECT: Private (Non-911) Ambulance Service Agreements RECOMMENDED ACTION Approve Agreements with private ambulance service providers authorizing operation at the Basic and Advanced Life Support level in response to non-911 calls for period July 1, 2011 through June 30, 2014, that have been approved by County Counsel as to form and legality. FISCAL IMPLICATIONS There is no impact on the General Fund as a result of this action. Private ambulance service providers are required to pay annual fees to the County in order to provide various levels of service in the County. These fees are scheduled to increase on July 1, CONTRACT HISTORY Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 21 Liz Kniss County Executive: Jeffrey V. Smith 1

22 BOS Agenda Date :June 7, 2011 On June 26, 2001, the Board of Supervisors approved the first agreement for the provision of non-911 advanced life support ambulance services for Priority One Medical Services. Since that time other ambulance services have been authorized to provide this service including Westmed Ambulance Service and Silicon Valley Ambulance Service (Priority One Medical Services no longer operate in the County). REASONS FOR RECOMMENDATION The Board of Supervisors adopted an ambulance ordinance in 1993 and designated the Emergency Medical Services (EMS) Agency as the entity responsible for enforcing the ordinance and issuing ambulance permits. The authority to execute agreements with EMS Service providers is provided in the California Code of Regulations, Title 22. Specifically, the Santa Clara County Ordinance Code, Section A18-262, requires that all permitted advanced life support providers have an executed agreement with the County for the purpose of operating Advanced Life Support level in response to non-911 codes. Section of the Health and Safety Code states that the local EMS agency shall plan, implement, and evaluate an emergency medical services system, in accordance with the provisions of this part, consisting of an organized pattern of readiness and response services based on public and private agreements and operational procedures. The written agreement specifies the scope of services to be provided by the ambulance provider, and authorizes the ambulance provider to utilize paramedics to deliver those services. BACKGROUND Non-911 ambulance services are those services used to transfer patients between hospitals, hospitals and skilled nursing facilities, urgent and sub-acute care facilities, etc. These ambulance services also play a critical role in assisting the County during times of EMS system surge and disaster. In Calendar Year 2009, approximately 40,000 interfacility transfers occurred in the County in addition to approximately 97, EMS responses in the County Exclusive Operating Areas (including those managed by American Medical Response and the Palo Alto Fire Department). Non-911 ambulances may be permitted at the Basic Life Support (staffed with emergency medical technicians), Advanced Life Support (staffed with paramedics), or Critical Care level (staffed with specially trained nurses or paramedics). Currently eight ambulance services are permitted in the County consisting of approximately 86 non-911 ambulances. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 22 Liz Kniss County Executive: Jeffrey V. Smith 2

23 BOS Agenda Date :June 7, 2011 Providers Permitted as of February 2011: American Medical Response (Advanced Life Support, Critical Care Transport, and Basic Life Support) Bayshore Ambulance Service (Critical Care Transport and Basic Life Support) Golden State Medical Services (Basic Life Support) Norcal Ambulance Service (Critical Care Transport) ProTransport-1 (Basic Life Support) Royal Ambulance (Critical Care Transport and Basic Life Support) Silicon Valley Ambulance (Advanced Life Support and Basic Life Support) Westmed Ambulance Service (Advanced Life Support, Critical Care Transport, & Basic Life Support) CONSEQUENCES OF NEGATIVE ACTION Failure to approve the recommended action may limit EMS Agency's ability to carry out its full scope of ambulance permitting functions and synchronize EMS service provider agreements. STEPS FOLLOWING APPROVAL Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 23 Liz Kniss County Executive: Jeffrey V. Smith 3

24 BOS Agenda Date :June 7, 2011 Return one (1) executed Ambulance Service Agreement with each provider to Public Health Department Administration, Attention: Contracts and Compliance Unit. ATTACHMENTS Agreement with Bayshore Ambulance Service Agreement with Golden State Ambulance Service Agreement with NORCAL Ambulance Service Agreement with Pro-Transport-1, LLC Agreement with Royal Ambulance Service Agreement with Silicon Valley Ambulance Service Agreement with Westmed Ambulance Service Supp. Info 1 - Agreement with American Medical Response Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 24 Liz Kniss County Executive: Jeffrey V. Smith 4

25 BOS Agenda Date :June 7, 2011 County of Santa Clara Public Health Department Emergency Medical Services PH DATE: June 7, 2011 Prepared by:. Per Schenck Interim EMS Director Reviewed by:. Josh Davies EMS Section Manager TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public Health Administrator SUBJECT: First Amendment to Contract with Rural/Metro for 911 Emergency Ambulance Services RECOMMENDED ACTION Approve First Amendment to Agreement with Rural/Metro of California (Rural/Metro) relating to providing 911 Emergency Paramedic and Ambulance Services for period July 1, 2010 through June 30, 2016, that has been reviewed and approved by County Counsel as to form and legality. FISCAL IMPLICATIONS There is no impact on the General Fund as a result of this First Amendment. The purpose of the First Amendment is to modify the original contract specific to Rural/Metro's Remote Access to County information technology systems, networks and related infrastructure. CONTRACT HISTORY Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 25 Liz Kniss County Executive: Jeffrey V. Smith 1

26 BOS Agenda Date :June 7, 2011 On December 14, 2010, the County and Rural/Metro entered into an Agreement, effective July 1, 2011, for the provision of Advanced Life Support First Response and Advanced Life Support Emergency Ambulance Services to the County for the County s Exclusive Operating Area (EOA). REASONS FOR RECOMMENDATION This First Amendment to the Agreement between the County and Rural/Metro of California Inc., relating to provision of Advanced Life Support Emergency Ambulance Service in the Santa Clara County EOA, will allow the County to grant Remote Access system privileges to Rural/Metro. "Remote Access" is the act of accessing County systems from a non-county network infrastructure. "County Systems" include personal computers, workstations, servers, mainframes, phone systems, and/or any device with network capabilities (e.g., a workstation with an attached modem, routers, switches, laptop computers, handheld devices). Remote Access privileges need to be granted for the purpose of Rural/Metro providing services and performing its obligations as set forth in the Agreement including, but not limited to, "the MARVLIS system", in accordance with the terms of the Agreement. BACKGROUND Mobile Area Routing and Vehicle Location Information System (MARVLIS) is a product of Bradshaw Consulting Services (BCS). Rural Metro has contracted with BCS to use MARVLIS as part of the new 911 paramedic ambulance contract effective July 1, MARVLIS is a family of integrated products designed to get 911 paramedic ambulances to the right location at the right time. The system uses geographic information system (GIS) technology combined with wireless communications and Global Positioning System (GPS). Specifically the system will provide intelligent routing, live graphical display of current and required resources and on-demand analysis of all Rural Metro 911 ambulances. CONSEQUENCES OF NEGATIVE ACTION Failure to approve the First Amendment to the Agreement between the County and Rural/Metro may prevent remote access privileges for Rural/Metro to access the County system, referred to as the MARVLIS system, in accordance with the terms of the Agreement. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 26 Liz Kniss County Executive: Jeffrey V. Smith 2

27 BOS Agenda Date :June 7, 2011 STEPS FOLLOWING APPROVAL Return one (1) executed First Amendment to Agreement with Rural/Metro to Public Health Department Administration, Attention: Contracts and Compliance Unit. ATTACHMENTS Agreement w/ Rural-Metro for 911 Emergency Paramedic and Ambulance Services First Amendment to Agreement with Rural/Metro for 911 Ambulance Services Exhibit P - Agreement with Rural Metro for 911 Ambulance Services Supp. Info 1 - Exhibit P Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 27 Liz Kniss County Executive: Jeffrey V. Smith 3

28 FIRST AMENDMENT TO EMERGENCY MEDICAL SERVICES AGREEMENT This First Amendment to Emergency Medical Services Agreement ( First Amendment ) dated as of June 7, 2011 ( the Effective Date ), is made and entered into by and between the County of Santa Clara, a political subdivision of the State of California (the County ) and Rural/Metro of California, Inc., a Delaware corporation ( Rural/Metro ). RECITALS A. The County and Rural/Metro entered into that certain Emergency Medical Services Agreement dated December 14, 2010 (the Original EMS Contract ) to provide Advanced Life Support First Response and Advanced Life Support Emergency Ambulance Services to the County for the County s EOA. B. The County and Rural/Metro now desire to modify the Original EMS Contract with regard to Rural/Metro s Remote Access to County information technology systems, networks and related infrastructure. AGREEMENT NOW, THEREFORE, in consideration of the foregoing, and of the conditions, terms, covenants and agreements set forth herein, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the County and Rural/Metro hereby agree that the Original EMS Contract is amended, as of the Effective Date as follows: 1. Defined Terms. Capitalized terms used and not otherwise defined herein shall have the same meaning as set forth in the Original EMS Contract. 2. EMS Contract. The Original EMS Contract as amended by this First Amendment is hereafter referred to as the EMS Contract. 3. Exhibit P. As of the Effective Date, Exhibit P attached hereto and incorporated herein by reference is added to the Original EMS Contract. 4. Exhibit P-1. As of the Effective Date, Exhibit P-1 attached hereto and incorporated herein by reference is added to the Original EMS Contract. 5. Entire Agreement; Amendment. The EMS Contract constitutes the full and complete agreement and understanding between the parties hereto and shall supersede all prior communications, representations, understandings or agreements, if any, whether oral or written, concerning the subject matter contained in the EMS Contract. The EMS Contract may not be amended, waived or discharged, in whole or in part, except by a written instrument executed by all of the parties hereto. Emergency Medical Services Agreement First Amendment Page 1 of 2 28

29 6. Force and Effect. Except as modified by this First Amendment, the terms and provisions of the Original EMS Contract are hereby ratified and confirmed and are and shall remain in full force and effect. Should any inconsistency arise between this First Amendment and the Original EMS Contract as to the specific matters which are the subject of this First Amendment, the terms and conditions of this First Amendment shall govern and prevail. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment as of the Effective Date. Agreed to for County of Santa Clara: Agreed to for Rural Metro: By: By: Dave Cortese, President Board of Supervisors Michael P. DiMino President and CEO Attest: Maria Marinos Clerk of the Supervisors Approved as to Form and Legality: Jennifer S. Sprinkles Deputy County Counsel Emergency Medical Services Agreement First Amendment Page 2 of 2 29

30 September 2010 SANTA CLARA COUNTY INFORMATION TECHNOLOGY USER RESPONSIBILITY STATEMENT INSTRUCTIONS In May 1995 the Board of Supervisors charged each County organization with the responsibility for ensuring that all County employees had read and signed a statement of responsibility concerning use of the County s networks and information systems. The resulting County wide User Responsibility Statement is intended as a minimum statement of User responsibility, and individual County Agencies and Departments may require Users to read and sign additional statements to meet any special requirements that apply within their own environments. The County User Responsibility Statement must be signed by anyone who might reasonably require access to a County network and/or information system. This includes all County employees, as well as any other individual who needs authorized access for County business purposes. All Users who are allowed to access County resources remotely must also sign an additional attachment specifically related to remote access; this is included as Attachment A of the User Responsibility Statement. In addition, Users who are granted approval to use a personally owned device for County business must also sign Attachment B of the User Responsibility Statement. By signing the Statement or its attachments, Users acknowledge that they have read and understand the contents and that violation of any of the provisions may result in disciplinary action, up to and including termination of employment and/or criminal prosecution. If an individual refuses to sign the Statement, the Department can choose to read the Statement to the individual, who will be required to verbally acknowledge understanding of the Statement s contents in the presence of two or more responsible managers. These managers will attest in writing that this reading and verbal attestation of understanding occurred. Failing this verbal acknowledgement of understanding, the involved individual will be denied access to all County information systems and networks. Each County organization is responsible for storing and maintaining the signed Statements of its own Users. All County organizations shall have their Users re execute the Statement and/or attachments annually, or whenever there is an update or other change to the Statement or attachments (Department Heads will be notified by the County CIO s office of any updates or changes to the Statement or attachments). Each County organization should identify a User Responsibility Statement Administrator. This is an occasional personnel function that should NOT be filled by a member of the organization s information system support staff. Because it is a i 30

31 September 2010 personnel function, a good choice would be an employee in an administrative position who is responsible for other routine personnel issues. The User Responsibility Statement Administrator is responsible for the following tasks: 1. Identifying employees and other Users within the organization that will need to read and sign the Statement, as well as the relevant attachments. 2. Managing the signing process, including arranging for any briefings to be held in conjunction with Users signing the Statement and attachments. 3. Maintaining the signed Statements and attachments. 4. Ensuring that new employees and other new Users read and sign the basic Statement and any relevant attachments, and that the Department signing process is performed by all Users on an annual basis. ii 31

32 September 2010 SANTA CLARA COUNTY IT USER RESPONSIBILITY STATEMENT This User Responsibility Statement establishes a uniform, County wide set of minimum responsibilities associated with being granted access to Santa Clara County information systems and/or County networks. A violation of this Statement may lead to disciplinary action, up to and including termination. Definitions County information systems and networks include, but are not limited to, all County owned, rented, or leased servers, mainframe computers, desktop computers, laptop computers, handheld devices (including smart phones, wireless PDAs and Pocket PCs), equipment, networks, application systems, data bases and software. These items are typically under the direct control and management of County information system support staff. Also included are information systems and networks under the control and management of a service provider for use by the County, as well as any personally owned device that a User has express written permission to use for County business purposes. County owned information/data is any information or data that is transported across a County network, or that resides in a County owned information system, or on a network or system under the control and management of a service provider for use by the County. This information/data is the exclusive property of the County of Santa Clara, unless constitutional provision, State or Federal statute, case law, or contract provide otherwise. County owned information/data does not include a User s personal, non County business information, communications, data, files and/or software transmitted by or stored on a personally owned device if that information/data is not transported across a County network or does not reside in a County owned information system or on a network or system under the control and management of a service provider for use by the County. A mobile device is any computing device that fits one of the following categories: laptops; Personal Digital Assistants (PDAs); handheld notebook computers and tablets, including but not limited to those running Microsoft Windows CE, PocketPC, Windows Mobile, or Mobile Linux operating systems; and smart phones that include and/or data storage functionality, such as BlackBerry, Treo, Symbian based devices, and iphones. Note that the category Mobile Device does not include devices that are used exclusively for the purpose of making telephone calls. A public record is any writing, including electronic documents, relating to the conduct of the people s business as defined by Government Code section Remote access is defined as any access to County Information Technology (IT) resources (networks or systems) that occurs from a non County infrastructure, no matter what technology is used for this access. This includes, but is not limited to, access to County IT resources from personal computers located in User s homes. 1 32

33 September 2010 Users includes County employees who are on the permanent County payroll, as well as any other individual who has been authorized to access County networks and systems. 2 33

34 September 2010 Key Points 1. General Code of Responsibility The following General Code of Responsibility defines the basic standards for User interaction with County information systems and networks. All Users of County information systems and networks are required to comply with these minimum standards. 1.1 Users are personally responsible for knowing and understanding the appropriate standards for User conduct, and are personally responsible for any actions they take that do not comply with County policies and standards. If a User is unclear as to the appropriate standards, it is that User s responsibility to ask for guidance from appropriate information systems support staff or Department management. 1.2 Users must comply with basic County standards for password definition, use, and management. 1.3 With the exception of County owned and approved devices issued to specific authorized County users, only authorized information systems support staff may attach any form of computer equipment to a County network or system unless express written permission to do so is given by Department management. This includes, but is not limited to, attachment of such devices as laptops, PDAs, peripherals (e.g., external hard drives, printers), and USB storage media. 1.4 The use of personally owned USB storage media on any County computer system is prohibited. All such devices must be County owned, formally issued to the User by the Department, and used only for legitimate County business purposes. 1.5 Connecting County owned computing equipment, including USB storage media, to non County systems or networks is prohibited unless express written permission has been given by Department management. This formal approval process ensures that the non-county system or network in question has been evaluated for compliance with County security standards. An example of a You are responsible for your own behavior. If you re unclear about a security standard, it s your responsibility to ask for guidance. You must comply with County password standards. Don t attach computer equipment of any kind to County systems or networks without permission. Use only County owned and issued USB storage media. Don t attach County equipment of any kind to non County computers or networks. 3 34

35 September 2010 Key Points permitted connection to a non-county system or network would be approved connection of a County issued laptop to a home network. 1.6 No User, including information systems staff, may install, configure, or use any device intended to provide connectivity to a non County network or system (such as the Internet), on any County system or network, without express written permission. All such connections must be approved in writing by the County Chief Information Officer (CIO) or designee. If authorized to install, configure or use such a device, the User must comply with all applicable County standards designed to ensure the privacy and protection of data, and the safety and security of County systems. 1.7 The unauthorized implementation or configuration of encryption, special passwords, biometric technologies, or any other methods to prevent access to County resources by those individuals who would otherwise be legitimately authorized to do so is prohibited. 1.8 Users must not attempt to elevate or enhance their assigned level of User privileges unless express written permission to do so has been granted by Department management. Users who have been granted enhanced privileges due to their specific jobs, such as system or network administrators, must not abuse these privileges and must use such privileges only in the performance of appropriate, legitimate job functions. 1.9 Users must use County approved authentication mechanisms when accessing County networks and systems, and must not deactivate, disable, disrupt, or bypass (or attempt to deactivate, disable, disrupt, or bypass) any security measure or security configuration implemented by the County Users must not circumvent, or attempt to circumvent, legal guidelines on software use and licensing. If a User is unclear as to whether a software program may be legitimately copied or 4 35 Don t install or activate communication devices, such as modems, on County computers or networks. Don t use encryption except when directed to do so. Don t attempt to enhance your assigned user privileges. Don t attempt to disable or bypass County login procedures. Follow the terms of all software licensing agreements.

36 September 2010 Key Points installed, it is the responsibility of the User to check with Department management or information systems support staff All software on County systems must be installed by authorized systems support staff. Users may not download or install software on any County system unless express written permission has been obtained from Department management or authorized system support staff Loss or theft of County owned computer equipment, or of personally owned computer equipment that has been approved for use in conducting County business, is to be reported immediately to designated Department management, administrative, or systems support staff. Users are also expected to be aware of security issues, and are encouraged to report incidents involving breaches of security, such as the installation of an unauthorized device, or a suspected software virus Users must respect the sensitivity, privacy and confidentiality aspects of all County owned information. In particular: Users must not access, or attempt to access, County systems or information unless specifically authorized to do so, and there is a legitimate business need for such access. Users must not allow unauthorized individuals to use their assigned computer accounts; this includes the sharing of account passwords. Users must not knowingly disclose County information to anyone who does not have a legitimate need for that information. Users must take every precaution to ensure that all information classified as either Confidential or Restricted (or an equivalent classification) is protected from disclosure to unauthorized individuals. Don t download or install software without permission. Immediately report the loss or theft of computer equipment, and also report any suspected security incidents. Don t access computers or data unless such access is related to your job. Don t share your user accounts or passwords with anyone. Don t share information with someone not entitled to have it. Protect sensitive data from those not authorized to see it. 5 36

37 September 2010 Key Points Users must not make or store paper or electronic copies of information unless it is a necessary part of that User s job Users must respect the importance of Countyowned systems and data as a valuable asset, and should understand that any data stored or processed on any County computer, or transmitted over any County network, is County property. In particular: Users must not change or delete data or information unless performing such changes or deletions is a legitimate part of the User s job function. Users must avoid actions that might introduce malicious software, such as viruses or worms, onto any County system or network. A User who leaves employment with the County must not retain, give away, or remove any County data or document from County premises, other than information provided to the public or copies of correspondence directly related to the terms and conditions of employment. All other County information in the possession of the departing User must be returned to the User s immediate supervisor at the time of departure Users should be aware that electronic information transported across any County network, or residing in any County information system, is potentially subject to access by County technical support staff, other County Users, and the general public. Users should not presume any level of privacy for data transmitted over a County network or stored on a County information system Users must respect all intellectual property rights, including but not limited to rights associated with patents, copyrights, trademarks, trade secrets, proprietary information, and confidential Don t make copies of information unless this is required by your job. Don t change or delete data unless doing so is part of your job. Don t introduce computer viruses onto County computers. When leaving County employment, don t take County data with you. You should have no expectation of privacy for electronic data stored on County computers. Respect all intellectual property rights associated with data that you deal with while doing your job. 6 37

38 September 2010 Key Points information belonging to the County or any other third party All information resources on any County information system or network are the property of the County and are therefore subject to County policies regarding acceptable use. No User may use any County owned network, computer system, or any other County owned device or data for the following purposes: Personal profit, including commercial solicitation or conducting or pursuing their own business interests or those of another organization Unlawful or illegal activities, including downloading licensed material without authorization, or downloading copyrighted material from the Internet without the publisher s permission To access, create, transmit, print, download or solicit material that is, or may be construed to be, harassing or demeaning toward any individual or group for any reason, including but not limited to on the basis of sex, age, race, color, national origin, creed, disability, political beliefs, organizational affiliation, or sexual orientation, unless doing so is legally permissible and necessary in the course of conducting County business To access, create, transmit, print, download or solicit sexually oriented messages or images, or other potentially offensive materials such as, but not limited to, violence, unless doing so is legally permissible and necessary in the course of conducting County business Knowingly propagating or downloading viruses or other malicious software Disseminating hoaxes, chain letters, or advertisements 7 38 Don t use County computers to conduct your personal business. Don t use County computers for illegal activities. Don t create or send demeaning or harassing material. Don t view, download, or send pornography or other potentially offensive materials. Don t download or transmit malicious software. Don t send chain letters.

39 September 2010 Key Points 1.18 Users that are employed by, or are otherwise associated with, a HIPAA impacted Department, are responsible for understanding and carrying out their responsibilities and duties as identified in the County HIPAA policies and procedures training, and other HIPAA related materials that may be distributed from time to time. Handle all protected health information according to HIPAA regulations. 2. Internet and The following items define the basic standards for use of County Internet and resources. All Users of County information systems and networks are required to comply with these minimum standards. 2.1 In general, Users must not use County systems or networks for personal activities. However, reasonable incidental (de minimus) personal use of County resources, such as Internet access and , is allowed as long as such use does not violate the County s acceptable use policies, and does not interfere with the performance of work duties or the operation of the County s information systems. If a User is unclear as to what is considered appropriate incidental personal use, it is the responsibility of the User to ask for guidance from Department management. 2.2 When conducting County business, Users may not configure, access, use, or participate in any Internet-based communication or data exchange service unless express written permission has been given by Department management. Such services include, but are not limited to, Internet Instant Messaging (such as AOL Instant Messaging), Internet services (such as hotmail and gmail), peer-topeer networking services (such as Kazaa), and social networking services (such as blogs, MySpace, Facebook and Twitter). Limit personal use of County computers. Don t use Internet or data exchange services (such as FaceBook, MySpace, or other social networking sites) to conduct County business. 8 39

40 September 2010 Key Points 2.3 It is the User s responsibility to become familiar with the specific County policies, procedures, and guidelines associated with the use of Internet-based communication and data exchange services. Users who have been granted permission to use an Internet-based communication or data exchange service for conducting County business are expected to adhere to all relevant County policies, procedures, and guidelines associated with the use of these services. 2.4 Users are responsible for understanding and following the County s policy with respect to the retention of messages, including immediately deleting non-business related messages once these messages have been read. 2.5 Users may not use an internal County account assigned to another individual to either send or receive messages. 2.6 Users may not configure their County account so that it automatically forwards messages to an external Internet system unless express written permission has been given by the Department Head. When automated forwarding is used, it must be for legitimate business purposes only, and is to be implemented with the User s full understanding of, and willingness to accept responsibility for, the associated risks for disclosure of sensitive information. You are responsible for understanding County guidelines for using Internet data exchange services, such as social networking sites. Follow County standards for retaining and deleting messages. Don t use anyone else s account. Don t automatically forward County to an Internet system. 3. Remote Access The following items define the basic standards for remote access to County information systems and networks. All Users of County information systems and networks are required to comply with these minimum standards. Users actually granted remote access privileges must sign the statement provided as Attachment A. 9 40

41 September 2010 Key Points 3.1 All remote access to County resources must be via the secure, centralized, County-controlled mechanisms and technologies approved by the County CIO or designee, and installed by authorized County systems support staff. Users are not permitted to implement, configure, or use any remote access mechanism other than the County-owned and managed remote access systems that have been formally approved and implemented by authorized system support staff. 3.2 Written approval for use of County remote access mechanisms is to be granted to a specific User by the appropriate Department Head or designee. Remote access to County resources will be implemented on a case-by-case basis based on job-related necessity, and only for those Users that have read and signed both the County s general User Responsibility Statement and the Remote Access agreement (Attachment A). 3.3 Remote access sessions may be monitored and/or recorded, and complete information on the session logged and archived. Users have no right, or expectation, of privacy when remotely accessing County networks, systems, or data. Audit tools may be used to create detailed records of all remote access attempts and remote access sessions, including User identifier, date, and time of each access attempt. 3.4 All computer devices used to access County resources from a remote location must be configured according to County-approved security standards. These include approved, installed, active, and current: anti-virus software, software or hardware-based firewall, full hard drive encryption, and any other security software or security-related system configurations that are required and approved by the County. 3.5 Users that have been provided with a Countyowned device intended for remote access use, such as a laptop or other Mobile Device, will Use only existing, approved County remote access systems. Get approval for all remote access to County systems. Remember that remote access sessions may be monitored and/or recorded. Computers used for remote access must be configured according to County standards

42 September 2010 Key Points take all reasonable measures to ensure that the device is protected from damage, access by third parties, loss, or theft. Loss or theft of such devices must be reported immediately to designated Department management or support staff. 3.6 Users will practice due diligence in protecting the integrity of County networks, systems, and data while remotely accessing County resources, and will immediately report any suspected security incident or concern to their Department management and IT support staff. 3.7 Remote access sessions are subject to all other relevant County IT security policies and standards, including Local User Authentication (passwords), Data Classification, Internet Use, and . Take measures to prevent the loss or theft of County owned Mobile Devices used for remote access, and report loss or theft of such devices immediately. Take appropriate measures to protect County computers and data when using remote access. When using remote access, continue to follow all County security policies. 4. Personally Owned Devices The following items define the basic standards for the use of personally owned devices to conduct County business. All Users of County information systems and networks are required to comply with these minimum standards. Users actually granted the privilege of using a personally owned device to conduct County business must also sign the statement provided as Attachment B. Note that in the case of Mobile Devices, the following provisions apply only to those devices that include and/or data storage capability (such as BlackBerry devices and other smart phones), and do not apply to devices that are used strictly for the purpose of making telephone calls. 4.1 Use of personally owned devices to conduct County business is prohibited unless express written permission is obtained from both the Department Head and IT Manager. If the User in question is a Department or Agency Head, express written permission must also be Use of a personally owned device to conduct County business requires approval

43 September 2010 Key Points obtained from the County Chief Information Officer or designee. The use of personallyowned devices to conduct County business is a privilege, not a right, and employment at the County does not automatically guarantee the granting of this privilege. 4.2 The personally owned device in question must use existing, County approved and Countyowned access/authentication systems when accessing County resources. Installation by Users of any hardware, software, or network interface components that provide unauthorized network connectivity, either wired or wireless, is prohibited. 4.3 The User shall allow the County to configure personally owned devices as appropriate to meet security requirements, including the installation of specific security software that is mandated by County policy. When reasonably possible and practical, the County shall strive to provide a minimum of 24 hours notice to the User before configuring the personally owned device. While the device is in the County s possession, the County shall not access, alter, retrieve or delete the User s personal information, communications, data, software or files stored on the device unless (a) it is reasonably necessary to do so to configure the device to meet security requirements, or (b) the User agrees to the specific access, alteration, retrieval or deletion. 4.4 Users authorized to use a personally owned device must follow designated Department procedures for ensuring that software updates and patches are applied to the device according to a regular, periodic schedule. All software installations and updates are subject to verification by management designated Department staff. If you are allowed to use your own computer or mobile device for County business, you must still use County approved user login procedures. You must allow authorized IT staff to configure, and periodically update, security software on any personallyowned device used to conduct County business. Follow Department procedures for updating and patching software on personally owned devices

44 September 2010 Key Points 4.5 Users have no expectation of privacy with respect to any County owned communications, information, or files on any personally owned device. Users agree that, upon request, the County may immediately access any and all work related or County owned communications, information or files stored on these devices, in order to ensure compliance with County policies. Except as otherwise provided in this policy or as required by law, the County shall not access any of the User s personal information, communications, data or files on the User s personally owned devices. 4.6 Upon reasonable suspicion that a User has failed to comply with County policy, the County may search and access communications, information, data, or files on the personally owned device that are reasonably related to the County s suspicion and interest in conducting the search. Any such search and access will take place with a goal of returning the device within 48 hours, if reasonably possible. The search and access shall be conducted in the presence of the User and/or the User s representative when requested by the User. At the request of the Department and with reasonable notice (not to exceed 48 hours), the User must provide a copy of all workrelated or County owned communications, information, or files stored on the personallyowned device. If the personally owned device contains any information which is subject to lawful privilege (such as attorney client or work product), that device shall be searched by Department representatives who are entitled to view the information, so that the privilege is not violated. 4.7 If a user is contacted on a personally owned device by someone from the County conducting County business, and the User has not obtained The County has the right to access County data on any personallyowned device used to conduct County business. The County may search a personally owned device if there is a suspicion that County policy has been violated

45 September 2010 Key Points permission to conduct County business with that personally owned device, then the County may not access that device regarding that Userreceived communication other than through legally permissible methods such as a subpoena, request for voluntary disclosure, etc. The preceding sentence shall not limit the County s right to direct a User to disclose the communication at issue upon reasonable notice. 4.8 The User shall adhere to all relevant County security policies and standards, just as if the personally owned device were County property. This includes, but is not limited to, policies regarding password construction and management, physical security of the device, device configuration, and hard drive sanitization prior to disposal. This does not restrict the User s personal use of the device so long as that personal use does not include or result in (a) the User s failure to adhere to all relevant County security policies and standards, or (b) the breach of the County s security policies or standards. 4.9 The User will make no modifications of any kind to operating system configurations implemented by the County on the device for security purposes, or to any hardware or software installed on the device by the County, without the express written permission of the County CIO s Office The User must treat the device and the workrelated or County owned communications, information or files it contains as County property. The User must not allow access to or use of any work related or County owned communications, information, or files by individuals who have not been authorized by the County to access or use that data The User must immediately report to designated Department management or The County will not require you to allow access to your personallyowned device for unsolicited, incoming County communications if that device has not been approved for use in conducting County business. Even when using your own computer or other device for County business, you must still follow all County security policies. Under most circumstances, you can continue to use an approved device for personal use as well as County business. Don t modify any security configuration settings or security software on your computer. Treat any personally owned device used for County business as if it were County owned

46 September 2010 Key Points support staff any incident or suspected incident of unauthorized access and/or disclosure of County resources, data, or networks that involve the device, including loss or theft of the device. Immediately report the loss or theft of a personally owned device that has been used for County business

47 September 2010 Key Points Acknowledgement of Receipt This Acknowledgement hereby incorporates the main body of the User Responsibility Statement. Attachments A and B are additional signature pages that apply only to those individuals that have been granted either remote access privileges (Attachment A) or permission to use a personallyowned device (Attachment B). These Attachments should only be signed if either of these conditions apply. The User should understand that the County s failure to enforce any provision of this Statement does not mean that the County will not enforce that or any other provision in the future. The User should also understand that if a clause, sentence or paragraph of this Statement is determined to be, invalid by a Court or County commission, this does not affect the validity of any other portion of the Statement. All Users must sign this Acknowledgement; Users with permission to use Remote Access should also sign Attachment A, and Users with permission to use personallyowned devices must complete and sign Attachment B. By signing below, I acknowledge that I have read and understand all sections of the County of Santa Clara s User Responsibility Statement. I also acknowledge that violation of any of its provisions may result in disciplinary action, up to and including termination of employment and/or criminal prosecution. If at any time, I have questions or doubts, or I feel ambivalent or unclear on any matter related to IT security and/or data confidentiality, I understand that it is my responsibility to request clarification from my supervisor or other appropriate manager before taking any action. Violation of any of the provisions in this User Responsibility Statement may result in disciplinary action. It is your responsibility to ask for clarification if you don t understand any aspect of the County IT security policy

48 September 2010 IT User Responsibility Statement Signature Page I acknowledge that this Statement will still be in effect following a transfer to another County Agency or Department, and that all of its provisions will continue to apply to me as long as I am a County employee. User Signature: Print User Name: Agency/Department: Date Signed: 17 48

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50 September 2010 Attachment A Remote Access Signature Page I have read and understand the contents of the User Responsibility Statement regarding Remote Access. I understand that violation of these provisions may result in disciplinary action, up to and including termination of employment and/or criminal prosecution. I received approval from my Department s management to be granted Remote Access privileges for legitimate County business, as evidenced by the signatures below. User Signature: Printed User Name: Date: Agency/Department: Agency/Department Manager Signature: Printed Manager Name: Manager Title: Date: 19 50

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52 September 2010 Attachment B Personally Owned Device Signature Page I have read and understand the contents of the User Responsibility Statement regarding the use of Personally Owned Devices. I understand that violation of these provisions may result in disciplinary action, up to and including termination of employment and/or criminal prosecution. I own the following device(s), which I will use for legitimate business reasons in compliance with County policies: Manufacturer Model Number Serial Number Operating System I received approval from my Department s IT Manager and my Agency/ Department head to use the device(s) listed above for legitimate County business, as evidenced by the signatures below. Agency/Department: User Signature: Printed User Name: IT Manager Signature: Printed IT Manager Name: Agency/Department Head (or Designee) Signature: Printed Agency/Department Head (or Designee) Name: County CIO Office Approval Signature: (Required only if User is Agency or Dept. Head) Printed CIO Office Approver Name: Date: Date: Date: Date: 21 52

53 EXHIBIT P REMOTE ACCESS 1. Scope of Access. a. Remote Access is the act of accessing County systems from a non-county network infrastructure. County Systems include personal computers, workstations, servers, mainframes, phone systems, and/or any device with network capabilities (e.g., a workstation with an attached modem, routers, switches, laptop computers, handheld devices). b. County hereby grants Remote Access privileges for Rural/Metro to access the following County systems, at the locations listed, collectively referred to as the MARVLIS system, in accordance with the terms of the Agreement: Servers used to support the MARVLIS system belonging to the Rural/Metro, located at County Communications Headquarters, 2700 Carol Drive, San Jose, CA. c. All other forms of access to the named Systems or to any County System that is not specifically named is prohibited with the exception of on-site access supervised by a County employee. d. Remote Access is granted for the purpose of Rural/Metro providing services and performing its obligations as set forth in the Agreement including, but not limited to, supporting Rural/Metro-installed programs, and access or retrieval of associated data contained in databases and file shares as required for Rural/Metro to fulfill contracted services and obligations. Any access to County systems and/or County data or information that is not specifically authorized under the terms of this Agreement is prohibited and may result in contract termination and any penalty allowed by law. e. County will review the scope of Rural/Metro s Remote Access rights periodically. Any modifications to Remote Access rights must be mutually agreed to in writing by County and Rural/Metro with the exception of those changes deemed necessary in emergency situations. 2. Security Requirements. a. Rural/Metro will not install any Remote Access capabilities on any County owned or managed system or network unless such installation and configuration is approved in writing by County s and Rural/Metro s respective designees. This includes any Rural/Metro owned system that is connected to a County network and/or housed in a County facility. b. Rural/Metro may only install and configure Remote Access capabilities on County systems or networks in accordance with industry standard protocols and procedures, which must be reviewed and approved by County s designee. c. Rural/Metro will only Remotely Access County systems, including access initiated from a County system, if the following conditions are met: Emergency Medical Services Agreement Exhibit P Page 53 1 of 4

54 i. Rural/Metro will submit documentation verifying its own network security mechanisms to County for County s review and approval. The County requires advanced written approval of Rural/Metro s security mechanisms prior to Rural/Metro being granted Remote Access. ii. Rural/Metro Remote Access must include the following minimum control mechanisms: a) Two-Factor Authentication: An authentication method that requires two of the following three factors to confirm the identity of the user attempting Remote Access. Those factors include: 1) something you possess (e.g., security token and/or smart card); 2) something you know (e.g., a personal identification number (PIN)); or 3) something you are (e.g., fingerprints, retina scan). The only exceptions are County approved County site to Rural/Metro site Virtual Private Network (VPN) infrastructure. b) Centrally controlled authorizations (permissions) that are user specific (e.g., access lists that limit access to specific systems or networks). c) Audit tools that create detailed records/logs of access attempts. d) All Rural/Metro systems used to Remotely Access County systems must have industry-standard anti-virus and other security measures that might be required by the County (e.g., software firewall) installed, configured, and activated. e) Access must be established through a centralized collection of hardware and software centrally managed and controlled by County s and Rural/Metro s respective designees. 3. Monitoring/Audit. County will monitor access to, and activities on, County owned or managed systems and networks, including all Remote Access attempts. Data on Rural/Metro activities will be logged on a County managed system and will include the date, time, and user identification. This includes any Rural/Metro owned system that is connected to a County network and/or housed in a County facility. 4. Copying, Deleting or Modifying Data. Rural/Metro is prohibited from copying, modifying, or deleting any data contained in or on any County Information System unless otherwise stated in the Agreement or unless Rural/Metro receives prior written approval from County. This does not include data installed by the Rural/Metro, or provided to Rural/Metro programs, to fulfill its obligations as set forth in the Agreement. 5. Connections to Non-County Networks and/or Systems. Rural/Metro agrees to make every effort to protect County s data contained on County owned and/or managed systems and networks within Rural/Metro s control from unauthorized access. Prior written approval is required before Rural/Metro may access County networks or systems from non-county owned and/or managed networks or systems. Such access will be made in accordance with industry standard protocols and procedures as mutually agreed upon and will be approved in writing by County in a timely manner. Remote Access must include the control mechanisms noted in Paragraph 2.c.ii above. Emergency Medical Services Agreement Exhibit P Page 54 2 of 4

55 6. Person Authorized to Act on Behalf of Parties. The following persons are the designees for purposes of this Agreement: Rural/Metro: Travis Kusman, Division General Manager County: Madelyn Thiessen and/or Dean Linebarger, Information Services Department (ISD) Either party may change the aforementioned names and or designees by providing the other party with no less than three (3) business days prior written notice. 7. Remote Access Provisions. Rural/Metro agrees to the following: a. Only Rural/Metro employees, agents and subcontractors approved by the County providing services or fulfilling Rural/Metro obligations under the Agreement will be given Remote Access rights. b. Any access to County Systems and/or County information that is not specifically authorized under the terms of this Agreement is prohibited and may result in contract termination and any other penalty allowed by law. c. An encryption method reviewed and approved by the County will be used. d. Rural/Metro will be required to log all access activity to the County. These logs will be kept for a minimum of 90 days and be made available to County upon request. 8. Remote Access Methods. a. All forms of Remote Access will be made in accordance with mutually agreed upon industry standard protocols and procedures, which must be approved in writing by the County. b. A Remote Access Back-Up Method may be used in the event that the primary method of Remote Access is inoperable. The Back-Up method must be approved in writing by the County. c. Rural/Metro agrees to abide by the following provisions: i. VPN Site-to-Site: The VPN Site-to-Site method involves a VPN connection from the vendor vehicles to a County VPN concentrator at the County site, with secure tunnels opened between the vehicles and the concentrator. If using the VPN Site-to-Site Method, Rural/Metro support staff will have access to the designated software, devices and systems within the County, as specified above in Paragraph 1.b. ii. County-Controlled VPN Client Access: The County will maintain control of an authentication hard token and a PIN number will be provided to the Rural/Metro for use as identification for Remote Access purposes. When the Rural/Metro needs to access County Systems, the Rural/Metro must first notify the County s designee. The County s Emergency Medical Services Agreement Exhibit P Page 55 3 of 4

56 designee will verify the PIN number provided by the Rural/Metro. After verification of the PIN the County s designee will give the Rural/Metro a one-time password which will be used to authenticate Rural/Metro when accessing the County s Systems. Rural/Metro agrees to the following: a) Because the PIN number allows access to privileged or confidential information residing on the County s systems the Rural/Metro agrees to treat the PIN number as it would a signature authorizing a financial commitment on the part of the Rural/Metro. b) The PIN number is confidential, County-owned, and will be identified as such. c) The PIN number must be kept in a secured environment under the direct control of the Rural/Metro, such as a locked office where public or other unauthorized access is not allowed. d) If the Rural/Metro s remote access equipment is moved to a non-secured site, such as a repair location, the PIN number will be kept under Rural/Metro control. e) The PIN number can only be released to an authorized individual under this amendment and may only be used by the designated individual. f) If the PIN number is compromised or misused, the Rural/Metro will notify the County s designee within one (1) business day. g) Rural/Metro will use the PIN number as part its normal business operations and for legitimate business purposes only. Any access to IS and/or County data information that is not specifically authorized under the terms of this Agreement is prohibited and may result in contract termination and any other penalty allowed by law. h) The PIN number will be issued to Rural/Metro following execution of this Agreement. i) The PIN number will be inactivated by the County s designee within five (5) business days following contract termination, or as required by the County for any reason. 9. County Information Technology User Responsibility Statement. Rural/Metro employees and agents and approved subcontractors shall comply with the County Information Technology User Responsibility Statement, attached as Exhibit P-1 to the Agreement. 10. Subcontracting. The use of subcontractors (including consultants) must be pre-approved in writing by County. Rural/Metro is responsible for the performance of its subcontractors. Rural/Metro must submit a copy of each Subcontractor Agreement to County at least fifteen (15) days prior to its effective date. Rural/Metro shall impose on its subcontractors those terms and conditions, which County is required to impose on Rural/Metro, including the terms of this Agreement and all amendments to the Agreement. If there is any conflict between this Agreement and Rural/Metro s subcontract agreement, the requirements of this Agreement shall control. Emergency Medical Services Agreement Exhibit P Page 56 4 of 4

57 BOS Agenda Date :June 21, 2011 County of Santa Clara Public Health Department Emergency Medical Services PH DATE: June 21, 2011 Prepared by:. Per Schenck Interim EMS Director Reviewed by:. Josh Davies EMS Section Manager TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public Health Director SUBJECT: Various Actions Related to Agreement with National Association of County and City Health Officials (NACCHO) for Medical Reserve Corps Unit (Santa Clara County Medical Volunteers for Disaster Response) RECOMMENDED ACTION Consider recommendations relating to the Santa Clara County Medical Volunteers for Disaster Response (MVDR) program. Possible action: a. Approve agreement with National Association of County and City Health Officials relating to capacity building of Medical Volunteers for Disaster Response in an amount not to exceed $5,000 for period January 5, 2011 through July 31, 2011, that has been reviewed and approved by County Counsel as to form and legality. b. Direct the Office of Budget and Analysis to increase the FY12 revenue and expense budgets for the Public Health Department Budget Unit 410 by $5,000. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 57 Liz Kniss County Executive: Jeffrey V. Smith 1

58 BOS Agenda Date :June 21, 2011 FISCAL IMPLICATIONS There is no impact on the General Fund as a result of this action. This one-time funding from the National Association of County and City Health Officials (NACCHO) in the amount of $5,000 will be used for expenses associated with recruitment of medically trained volunteers. The Department is requesting that the Office of Budget and Analysis budget these funds in FY12 in Budget Unit 410 Emergency Medical Services cost center The $5,000 revenue should be budgeted in account The $5,000 expense should be budgeted $500 in account , $1,500 in account , $500 in account , $1,500 in account and $1,000 in account CONTRACT HISTORY On May 1, 2007, the Board of Supervisors approved an agreement with NACCHO for the provision of expenses related to training for Santa Clara County's Medical Volunteers for Disaster Response (MVDR) program for the period May 11, 2007 through July 31, "Medical Volunteers Disaster Response" is the title that the County chose for NACCHO's Medical Reserve Corps (MRC) program that is unique to Santa Clara County. On April 21, 2009, the Board approved a second agreement with NACCHO for the purpose of further building capacity for the MRC for the period January 1, 2009 through July 31, The third NACCHO Agreement ending July 31, 2010, was approved by the Board of Supervisors on June 8, The fourth NACCHO Agreement ending July 31, 2011, was received in final form on June 7, 2011, thus precluding submission to the Board before this time. REASONS FOR RECOMMENDATION Medical Volunteers for Disaster Response is a network of volunteer medical professionals housed in the Emergency Medical Services Agency (EMS Agency). On March 7, 2006, MVDR was officially registered with the Office of the U.S. Surgeon General, Medical Reserve Corps Unit, in the Department of Health and Human Services. Currently, over 450 health care professionals are registered in the MVDR program with approximately 200 active members. Members are comprised of emergency medical Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 58 Liz Kniss County Executive: Jeffrey V. Smith 2

59 BOS Agenda Date :June 21, 2011 technicians, paramedics, nurses, physicians, dentists, and other allied health professionals. Approval of the recommended actions will assist in covering the on-going costs of maintaining the MVDR Program. BACKGROUND The Medical Volunteers for Disaster Response (MVDR) Program is a critical component of the County's ability to respond to medical-health emergency and disaster. This cadre of professional health care providers will assist the County in being able to respond to medical surge events that may include natural and manmade disaster. In the past year, the MVDR Program has continued to assist with medical monitoring of law enforcement officers, hazardous materials response preparation, in addition to participating in various exercises. MVDR personnel meet and training on a regular basis through monthly offerings coordinated by the EMS Agency. CONSEQUENCES OF NEGATIVE ACTION Not approving the recommendation may result in loss of funding for capacity building of medically trained volunteers. STEPS FOLLOWING APPROVAL Please return two (2) executed contracts and two (2) completed certifications as required by NACCHO to Public Health Department Administration, Contracts and Compliance Unit. ATTACHMENTS Agreement with NACCHO for MRC Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 59 Liz Kniss County Executive: Jeffrey V. Smith 3

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66 BOS Agenda Date :June 21, 2011 County of Santa Clara Public Health Department Emergency Medical Services PH DATE: June 21, 2011 Prepared by:. Patricia Natividad Management Analyst Reviewed by:. Per Schenck Interim EMS Director TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public Health Director SUBJECT: 2010 Santa Clara County Emergency Medical Services Plan RECOMMENDED ACTION Adopt the 2010 Santa Clara County Emergency Medical Services Plan and authorize submission to the California Emergency Medical Services Authority. FISCAL IMPLICATIONS There is no impact to the General Fund as a result of this action. There is no monetary transaction involved with the plan/update. REASONS FOR RECOMMENDATION The Santa Clara County Emergency Medical Services (EMS) Plan provides a framework for the ongoing development and enhancement of the County's EMS System. The Plan requires the County to validate adherence to various regulatory requirements and guidelines. Due to Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 66 Liz Kniss County Executive: Jeffrey V. Smith 1

67 BOS Agenda Date :June 21, 2011 the length of the 2010 EMS Plan, the document is on file with the Clerk of the Board of Supervisors. Pursuant to Section of the California Health and Safety Code, each local EMS Agency must develop and submit an annual update of its approved EMS Plan to the California Emergency Medical Services Authority. The 2010 EMS Plan fulfills the statutory requirement and brings the EMS Agency's plan up-to-date. The annually updated EMS Plan must be adopted by the Board of Supervisors prior to submission to the State. Plans are submitted annually for the previous year (retrospective review). As noted in the Data Collection/System Evaluation section of the plan, the County does not currently meet the recommended guideline for an integrated data management system (6.05) which supports its system wide planning, evaluation and QA/QI audit of the care provided to EMS patients. The EMS Agency has been working to address this matter. In 2007, the EMS Agency released a request for proposal (RFP) to obtain the services of a consultant for completion of Phase 1 of the process, a countywide assessment of all information technology systems existent among the provider agencies. But unfortunately the successful bidder and the County were unable to come to agreement on certain aspects of the contract. In 2008, a second RFP was released and a new consulting firm was selected. The new firm began work on the data assessment project in January 2009 and completed Phase I of the project in June The consultant provided a final report document which provided a comprehensive assessment of the current EMS Data System inclusive of workflow processes, data elements, technology applications, and IT systems used by all Santa Clara EMS Providers, as well as recommendations for implementing Phase II of the project. Phase II consists of the preparation, development and execution of a Request for Proposal (RFP). Included in the Annual Report on EMS Fines and Penalties Trust Fund provided to the Health and Hospital Committee on April 14, 2010, funding was requested to allocate funds for Phase II of the project. Due to time constraints, various stakeholder input and the RFP development process, the funding for Phase II has been rolled over into FY12. It is expected that Phase II will be completed by the end of FY12. The entire, fully implemented Prehospital Data System may cost as much as $ million over the next one to two years. BACKGROUND The 2009 Santa Clara County EMS Plan was adopted by the Board of Supervisors on June 8, 2010 and was submitted to the California Emergency Medical Services Authority. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 67 Liz Kniss County Executive: Jeffrey V. Smith 2

68 BOS Agenda Date :June 21, 2011 CONSEQUENCES OF NEGATIVE ACTION Failure to accept the recommended action will delay submission of the 2010 Santa Clara County EMS Plan to the California Emergency Medical Services Authority. ATTACHMENTS 2010 EMS Plan Update Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 68 Liz Kniss County Executive: Jeffrey V. Smith 3

69 County of Santa Clara Public Health Department Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San José, CA voice fax 2010 EMERGENCY MEDICAL SERVICES PLAN Due to the length of the 2010 EMS Plan, the document is on file with the Clerk of the Board of Supervisors located at 70 W. Hedding Street, 10 th floor San Jose, CA

70 BOS Agenda Date :June 21, 2011 County of Santa Clara Public Health Department PH DATE: June 21, 2011 Prepared by:. Per Schenck Interim EMS Director Reviewed by:. Josh Davies EMS Section Manager Per Schenck Interim EMS Director TO: Board of Supervisors FROM: Dan Peddycord, RN, MPA/HA Public Health Director SUBJECT: Second Amendment to Contract with Rural/Metro for 911 Emergency Ambulance Services RECOMMENDED ACTION Consider recommendations relating to Agreement with Rural/Metro for 911 Emergency Ambulance Services. Possible action: a. Approve Second Amendment to Agreement with Rural/Metro of California (Rural/Metro) relating to providing 911 Emergency Paramedic and Ambulance Services for the period beginning July 1, 2011 and ending June 30, 2016, that has been reviewed and approved by County Counsel as to form and legality. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 70 Liz Kniss County Executive: Jeffrey V. Smith 1

71 BOS Agenda Date :June 21, 2011 b. Approve delegation of authority to the County Executive or his designee, to execute all documents necessary or appropriate for the County to place liens on property offered as security by Rural/Metro under the 911 Emergency Paramedic and Ambulance Services contract, after review and approval of the same as to form and legality by County Counsel. FISCAL IMPLICATIONS There is no impact on the General Fund as a result of this Second Amendment. The purpose of the Second Amendment is to modify the original contract to allow Rural/Metro to post a $5 Million letter of credit in lieu of the original lockbox account as envisioned in the 911 Emergency Paramedic and Ambulance Services contract. CONTRACT HISTORY On December 14, 2010, the County and Rural/Metro entered into an Agreement, effective July 1, 2011, for the provision of Advanced Life Support First Response and Advanced Life Support Emergency Ambulance Services to the County for the County s Exclusive Operating Area (EOA). On June 7, 2011, the Board of Supervisors approved the First Amendment to the Agreement for the purpose of modifying the original contract specific to Rural/Metro's Remote Access to County information technology systems, networks and related infrastructure. REASONS FOR RECOMMENDATION The original 911 Emergency Paramedic and Ambulance Services contract called for certain assurances to be offered by Rural/Metro in case of a default. There were 4 primary assurances: 1. a lien on the ambulance fleet; 2. a $5 Million performance bond; 3. a corporate guaranty from Rural/Metro s publicly traded parent corporation; and 4. a lockbox account holding Rural/Metro s operating funds for the County of Santa Clara. Certain Medicare payment requirements made it difficult for Rural/Metro to provide the lockbox as originally envisioned in the Ambulance Service Contract. Instead of the lockbox account, under the Second Amendment, Rural/Metro will provide the County a substitute Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 71 Liz Kniss County Executive: Jeffrey V. Smith 2

72 BOS Agenda Date :June 21, 2011 assurance for item 4. The substitute assurance has two components, a $5 Million letter of credit and control of a Rural/Metro bank account in the event it should default. The primary substitute item for the County is the $5 Million letter of credit. The security provided by Rural/Metro through items 1 through 3 remains unchanged. BACKGROUND The County executed the 911 Emergency Paramedic and Ambulance Services contract with Rural/Metro which will begin on July 1, Prior to commencing operations, Rural/Metro is required to establish certain accounts and provide collateral to the County. Through the process of establishing the accounts in accordance with the 911 Emergency Paramedic and Ambulance Services contract, Rural/Metro determined it would need to provide an alternative assurance to a lockbox account holding Rural/Metro s operating funds for the County of Santa Clara. CONSEQUENCES OF NEGATIVE ACTION Failure to approve the Second Amendment to the Agreement between the County and Rural/Metro may prevent the incorporation of necessary provisions specific to Operational and Control Accounts into the County's Agreement with Rural/Metro for 911 Emergency Ambulance Services. STEPS FOLLOWING APPROVAL Return two (2) executed Second Amendment to Agreement with Rural/Metro to Public Health Department Administration, Attention: Contracts and Compliance Unit. ATTACHMENTS Agreement w/ Rural-Metro for 911 Emergency Paramedic and Ambulance Services First Amendment to Agreement w/rural-metro for 911 Emergency Paramedic and Amublance Services Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 72 Liz Kniss County Executive: Jeffrey V. Smith 3

73 BOS Agenda Date :June 21, 2011 Supp. Info 1 - Second Amendment to EMS Agreement Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 73 Liz Kniss County Executive: Jeffrey V. Smith 4

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83 Committee Agenda Date :August 10, 2011 County of Santa Clara Public Health Department Emergency Medical Services PH DATE: August 10, 2011 Prepared by:. Josh Davies EMS Section Manager Reviewed by:. Michael Petrie EMS Director TO: Supervisor.Liz.Kniss, Chairperson Supervisor.Ken.Yeager, Vice Chair Health & Hospital Committee FROM: Dan Peddycord, RN, MPA/HA Public Health Director SUBJECT: 911 Ambulance System Report for the Santa Clara County Exclusive Operating Area RECOMMENDED ACTION Accept report from the Emergency Medical Services (EMS) Agency regarding the status of of the agreement and transition of 911 Medical Ambulance Services with Rural/Metro of California. FISCAL IMPLICATIONS The County General Fund is not adversely impacted by this service agreement. Rural Metro supports the County EMS Agency with a $1.5 million dollar annual franchise fee. This funding allows the EMS Agency to operate without encumbering the County General Fund. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 83 Liz Kniss County Executive: Jeffrey V. Smith 1

84 Committee Agenda Date :August 10, 2011 CONTRACT HISTORY On December 14, 2010, the Board of Supervisors approved a (5) five-year service agreement with Rural/Metro of California. Rural/Metro is a new ambulance service provider in the County and replaced American Medical Response (AMR) effective July 1, 2011 as the County Exclusive Operating Area 911 ambulance and paramedic service provider (excluding the City of Palo Alto and Stanford Land Parcels). The service agreement with Rural/Metro permits up to two (2), (3) three-year extensions by the Board of Supervisors. REASONS FOR RECOMMENDATION At the December 14, 2010 Board of Supervisor Meeting, Supervisor Kniss 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.The first of these reports occurred on April 13, At the request of Supervisor Yeager at the April 13, 2011 meeting, an additional pre-contract implementation update/report was provided at the June 8, 2011 Health and Hospital Committee. This report was the first of post-implementationquarterly reports, scheduled for August and November of 2011 and February, and May of 20112, and each quarter thereafter. BACKGROUND. Rural/Metro Activities.. Rural/Metro assumed the 911 paramedic and emergency ambulance service responsibilities. on July 1, The transition went well with Rural Metro staging ambulances and crews. in the late hours of June 30th... The transition from American Medical Response (AMR) to Rural/Metro occurred on schedule between 12:00-12:35 am on July 1, At midnight June 30, all new calls were routed to Rural Metro. At this point Rural Metro was fully deployed, connected to County Communications dispatching, and all subsequent EMS call were handled well by Rural.. Metro. AMR completed their last call by 1:00 a.m. The transition of providers did not result in any known negative impacts to the 911 System or patients served by the Santa Clara County Emergency Medical Services System. Overall, the transtion went well. All critical dispatching and operational components are in place and functioning well. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 84 Liz Kniss County Executive: Jeffrey V. Smith 2

85 Committee Agenda Date :August 10, AMR, Rural/Metro, County EMS, and County Communications personnel worked together. to facilitate a smooth transition. An Event Action Plan guided the transition and provided a. foundation for contingency actions, should such actions have become necessary... At the time this report was drafted, Rural/Metro had been in operation 18 days, during.. which time they have operated smoothly, without critical incidents or unresolvable issues... Rural Metro offers an ehnanced deployment intelligence software, called MARVIS, that aides in the staging of Amublance units for improved reponse. This new technology is being synchronized with the County information infrastructure and should be complete by the end. of July. Once fully implemented, response times and system efficiency should be positively impacted... At the July 6th Fire Chiefs meeting, praise was offered to the handling of the transtion and remarks were complimentary of Rural Metro. The Fire Chiefs expressed their satisfaction. with the professionalism and performance of Rural Metro. The July 4th Milpitas FireWorks. event was noted as a true "test" of the EMS system, with the footnote that system and Rural Metro performed admirably..... General Process Activities Related to the Transition. The EMS Agency has completed the execution of all agreements with fire departments within the County 911 Exclusive Operating Area. These agreements authorize fire departments to provide first responder emergency medical services. The Board approved.. delegation of authority for these agreements in May Additional EMS Service Provider Agreements will be executed with the City of Palo Alto, NASA/AMES Fire Department, and various volunteer fire departments providing EMS in the County... The Board of Supervisors has approved two amendments to the Agreement between the County and Rural/Metro. The first amendment added a data sharing agreement exhibit; the.. second clarified details of the financial security process, commonly referred to as the "lock box".... Quarterly EMS Field Personnel "Town Hall" meetings will continue. These meetings. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 85 Liz Kniss County Executive: Jeffrey V. Smith 3

86 Committee Agenda Date :August 10, 2011 provide a forum for field paramedics and EMTs to interact with the EMS Agency, discuss areas of concern, and offer suggestions for system improvement American Medical Response Transition... AMR has transitioned to their service to provide only non-911 ambulance response in. Santa Clara County. AMR provides interfacility ambulance transfer services within the. County, consistent with County Ordinance... The EMS Agency continutes to monitor AMR's performance to assure they have complied with response time standards throughout the term of their provider agreement. The review process contained in the agreement with AMR provides a 90-day response time review. period to adjust data for allowable exemptions. All AMR performance data will be. reviewed and finalized in September. Should AMR fail to meet response time compliance, the County has the ability to implement a "Lame Duck" penalty of up to $200,000, in addition to any late response penalties... CONSEQUENCES OF NEGATIVE ACTION The Health and Hospital Committee will not receive the information requested from the EMS Agency. Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, 86 Liz Kniss County Executive: Jeffrey V. Smith 4

87 Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San Jose, CA fax Prehospital Providers Advisory Committee June 23, :00 PM 3:00 PM Santa Clara City Fire Department Training Center Conference Room 1900 Walsh Avenue, Santa Clara Draft Minutes Welcome, Introductions & Announcements Committee Chair / Vice Chair: Kellen Parker, Royal Ambulance (Chair) Angela Jacobs, San Jose Fire (Vice-Chair) Michael Cabano, EMS Agency Representative EMS System Stakeholders: Reggie Willams-San Jose Fire Jeff Cole-Mountain View Fire Brian Smart- Westmed College John Kralyevich- Westmed College John Blain Santa Clara County EMS Kirsten Muehlenberg- Santa Clara County EMS Tino Arellano- Santa Clara County EMS Mark Frise- Santa Clara County EMS Kim Roderick-Palo Alto Fire Sean Young-Royal Ambulance Dan Bobier- ProTransport-1 Tyler Draeger-ProTransport-1 Anthony Melendrez- San Jose Fire Rose Marino-County Communications Robert Guerrero-Rural Metro Danny Vollberg-Rural Metro Kristie Jones-AMR Randy Hooks-Silicon Valley Ambulance Daren McMillen-Cal Fire Scott Brown- Milpitas Fire Anthony Madreros-SCCFD Charlene Donahue- Sunnyvale Fire Rick Harsh- Santa Clara City Fire Bob Cascone-Santa Clara County EMS Chris Seymour- Westmed Ambulance 87

88 Review & Approve Minutes Chairman and Vice chair Elections: Rural Metro Updates: John Blain, EMS Agency: EMS Agency personnel updates: Michael Cabano, EMS Agency EMS Specialist Positions Michael Cabano, EMS Agency Communications updates: John Blain, EMS Agency Clinical Performance indicators: Kirsten Muehlenberg, EMS Agency Field Protocol Guides Updates: Kirsten Muehlenberg, EMS Agency: February minutes accepted and approved? Motion to approve by 1 st : Reggie Williams 2 nd : Angela Johnson Jason Weed has vacated the position of Chairman due to his appointment with County EMS Agency. The position of Chairman was awarded and approved for Vice Chair Kellen Parker to accept. Parker accepts Chairman Position. Nominations were open for Vice Chair. Reggie Williams nominated Captain Angela Jacobs from San Jose Fire. Nomination was accepted by Jacobs and approved by Committee. No representatives from Rural Metro were in attendance. John Blain addressed the committee on behalf of Rural Metro. Many concerns were brought up from Fire Department attendees about the transition, use of new equipment and lack of training for Fire personnel prior to transition day. John Blain addressed these concerns and took notes to follow through on these concerns with Rural Metro. EMS Director has been hired and it was announced that Michael Petrie will join the EMS Agency in July to assume the role of EMS Director New EMS Specialist hires have concluded and Jason Weed and Bob Cascone have been hired as the New Specialists. Bob will be assigned to the Clinical Quality Improvement Position and Jason Weed will be assigned to Investigations and Compliance. Michael Clark and Michael Cabano will be assigned to the Field Operations position handling the EMS Duty Chief role 7 days a week in the field from HRS. The Agency anticipates a hiring for an EMS Specialist positions to begin shortly. Several Communications changes will take effect beginning July 1, 2011 that will effect the naming of the current EMS Radio Channels. EMS Radio User Guide will be updated and show changes. s have been sent to all providers, please check them and follow the instructions attached. More information to be provided at the MAC Meetings All Agencies have picked up their Field Protocol Guides. There was still some available if anyone needed any, please contact Kirsten. Remind personnel that when changes are made to the 88

89 Quality Improvement items Kirsten Muehlenberg, EMS Agency : guide the most current information will be contained on the EMS Agency website. Changes to policy 214, 208 and 211 to be brought up. Policy 302 was reviewed in full and dissected for any issues and discrepancies. All providers in attendance provided comment and feedback to assist with the process of changes. IAP Update for Transition Day: John Blain, EMS Agency: Operational Changes Effective in July: John Blain, EMS Agency Review of Recent Training Opportunities: Michael Cabano, EMS Agency Upcoming Homeland Security Training opportunities: Tino Arellano, EMS Agency Report on MVDR and MRC program: Tino Arellano and Mark Frise, EMS Agency Roundtable: IAP has been written and has multiple levels of back up and padding to prevent any issues with the transition. More concern was brought up about Rural Metro and transition Day from fire department personnel, John Blain, to address and follow up with Rural Metro Changes that will become effective on July 1, 2011 will affect the re-naming of current EMS Radio Channels, Package Reponses to MPMP Activations and FAA Alerts at the Airports. There will also be the new assignment of the Field Operations position within the EMS Agency. EMS Field Supervisor and EMS Duty Chiefs will have quite a bit more interaction and assist with County Special Teams deployments. Hospital Active Shooter Exercise was held on March 29. Division/Group Supervisor School was held on April by CalFire. ICS 300 Course was held on April by EMS Agency. ICS 400 Course was held on May by EMS Agency. Request was made from EMS Agency to have providers advise on courses that they would be interested in seeing the County bring to our operational area. Feedback can be provided to Tino via or phone call. MVDR membership growing and steady recruitments continue. MVDR s completed a Skilled Nursing Evacuation Exercise in conjunction with the SNF Cluster groups on June 4 with Cedar Crest Nursing Center. MVDR participated in the 2011 County WildFire Drills on June 8, June 16 and June 24. No additional items provided at the Roundtable. 89

90 Adjournment: Completion of Meeting Minutes Next meeting: September 22, 2011 from HRS Santa Clara City Fire Training Center 1900 Walsh Avenue, Santa Clara Kellen Parker, Royal Ambulance, Chairman 90

91 County of Santa Clara Public Health Department Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San José, CA voice fax Medical Control Advisory Committee June 23, :00 AM 12:00 PM Santa Clara City Fire Department Training Facility Class Room 1900 Walsh Avenue, Santa Clara Welcome, Introductions & Announcements Review & Approve Minutes Committee Chair : Adrian Ayllon, American Medical Response EMS System stakeholders: Eric Rudnick, Santa Clara County EMS Agency Kirsten Muehlenberg, Santa Clara County EMS Agency Bob Cascone, Santa Clara County EMS Agency Josh Davies, Santa Clara County EMS Agency Joe Kraut, Silicon Valley Ambulance Fran Abbruzzese, CalSTAR Chad Henry, Rural/Metro Joel Levis, Kaiser Santa Clara ED Charlene Donahue, Sunnyvale DPS Brian Smart, WestMed College John Kralyevich, WestMed College Elizabeth Shelley, WestMed College Anne Marcotte, Santa Clara County EMS Agency Kim Roderick, Palo Alto Fire Dept. Shanna Kuempel, Santa Clara County Fire Dept. Rick Harsh, Santa Clara City Fire Dept. Anthony E. Madieros III, Santa Clara County Fire Dept. Vernell Smith, VMC Base Hospital Angela Jacobs, San Jose Fire Dept. Reginald Williams, San Jose Fire Dept. Anthony Melendez, San Jose Fire Dept. February 24, 2011 minutes accepted and approved with the following corrections: Policy 302 has not gone out for public comment. Action Items Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V. Smith 91

92 Review/Addendu m of Agenda Medical Director s Report - Dr. Eric Rudnick, EMS Agency Old Business Review of portions of the policy development process. Remove item #5 from agenda, Equipment Procurement Subcommittee report; no subcommittee members present today. EMS Agency recruiting an EMS Specialist. New EMS Director Mike Petrie due to start July 5. EMS Commission has survived budget elimination so far. New EMT training requirements, increasing hours. State EMSA proposed Paramedic regulation changes will more closely align with the National model. Upcoming Advanced Practice Paramedic scope. Hospital Diversion No current plans to eliminate. CCT-P scope of practice. Left Ventricular Assist Device (LVAD). Specialty Programs Anne Marcotte, EMS Agency: Trauma Trauma Care System Quality Improvement Committee: falls of elderly on prescription blood thinners and with ALOC may be better served going to a Trauma Center. Joel Levis, KSC - wishes to be involved with the review of the trauma triage criteria due to Kaiser repatriation issues. Dr. Rudnick will take this to SBMDA for discussion. STEMI encounter to balloon times holding at < 80 minutes: considered to be good. Stroke Focus is on TPA treatment within 60 minutes of arrival. Protocol Book Review Subcommittee Tony Madieros EMS-700 Manual Dr Rudnick EMS Update Train-The-Trainer Kirsten Muehlenberg Confirmed date of September 15, 2011 at the City of Santa Clara Fire Training Facility Dr. Rudnick: research use of CPR in LVAD failure patients and choice of destination. Kirsten Muehlenberg - Develop refresher training regarding use of EMT partner on elderly fall patients on aspirin. Dr. Rudnick will take the issue of elderly fall patients on anticoagulants or aspirin to the attention of SBMDA. Tony Madieros Develop a free app for the protocols. New subcommittee members to review and decide on top examples of a new style for the protocol manual. Dr. Rudnick - will review ALCO protocols if appropriate for use in 92

93 New Business EQIP Annual Updates Medical Control Review Best Practices Roundtable San Jose Fire Department Announcement that Captain Angela Jacobs is taking over the Training Coordinator position for the retiring Dave Huseman. Refusal of Service Policy Josh Davies & Dr. Rudnick Bob Cascone (EMS Agency) The annual updates were due May Clinical Performance Indicators (CPI) Due to the EMS Agency July 18, 2011 Clinical Protocol Development and Update Tourniquet Induced Hypothermia. Peri-laryngial airways (King, tube, LMA, etc.) may cause carotid compression similar to applying a cervical collar, and interfere with cerebral circulation. Dr. Rudnick These are not ready yet. Dr. Vernell Smith (VMC Base) Low ET Tube. Dr Rudnick hands out abstract article. Dr. Joel Levis (Kaiser Santa Clara) how will EKG SCCo. Each fire agency for the next MAC meeting, how much is their department willing/able to pay for a new format/style of protocol manual. Dr. Rudnick & Bob Cascone complete Administrative Orders, Best Practices & update website. Shanna Kuempel will scan CNT patient refusal form/policy and send to Dr. Rudnick. Bob Cascone notice to providers who have not submitted their EQIP updates. Kirsten Muehlenberg add EQIP session to EMS Update TTT class, Sept 15. Bob Cascone & Chad Henry Schedule meeting/demonstration on TapChart and generating CPI reports. Chad Henry will 93

94 Announcement of Next Meeting Adjournment transmission arrive? Next meeting Conflict: Dr. Rudnick will not be available September 22. Special Session: Date/Time: August 25; 0830 thru Meeting adjourned. ensure the 12-lead EKGs transmitted from the field come as a hard copy notification to the ED. All: save the date of August 25, for discussion of revisions to the Refusal of Service policy. Reggie Williams will check if SJFD will host the meeting at BFO. Minutes produced by Bob Cascone, Santa Clara County EMS Agency 94

95 County of Santa Clara Public Health Department Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1200 San José, CA voice fax EMS Trust Fund County Fiscal Year 2012 Revised September 7, 2011 FY12 Beginning Balance $1,424,600 FY12 Current Receipts + $215,297 FY12 Expenditures - $1,350,000 Current Balance $289,897 CATEGORY A - No less than $342, A-01: EMS System Reserve Investment Description Approved Actual Balance Allocation (minimum) 342, , Final CATEGORY B Maximum $150, B-01: EMS System Information to the Public Description Approved Actual Balance Allocation (maximum) 25, , EMS System Video 2012-B-02: Training (not funded by grants or other sources) Description Approved Actual Balance Allocation (maximum) 40, , EMS Coordinators Orientation Meeting B-03: Exercises (not funded by grants or other sources) Description Approved Actual Balance Allocation (maximum) 40, , Ambulance Strike Team Leader Board of Supervisors: Mike Wasserman, George Shirakawa, Dave Cortese, Ken Yeager, Liz Kniss County Executive: Jeffrey V. Smith 1 95

96 2012-B-04: EMS Conference Description Approved Actual Balance Allocation (maximum) 35, , Facility and Food Honoraria 2012-B-05: EMS Provider Recognition and National EMS Week Description Approved Actual Balance Allocation (maximum) 10, , Pad Folios EMS Coordinators EMS System Decals and Stickers Stakeholder Plaques CATEGORY C Maximum $108, C-01: Description Approved Actual Balance Allocation (maximum) 2012-C-02: Description Approved Actual Balance Allocation (maximum) 2012-C-03: Description Approved Actual Balance Allocation (maximum) 2012-C-04: Description Approved Actual Balance Allocation (maximum) CATEGORY D Maximum $250, D-01: Description Approved Actual Balance Project 1: EMS Data Unanticipated Costs Project 2: EMS System Assessment Part I 2 96

97 FY2011 Roll-Over Maximum $500, Roll Over: EMS Data Project Description Approved Actual Balance 3 97

98 Sent via August 22, 2011 John Blain Santa Clara County Emergency Medical Services Agency 976 Lenzen Avenue, Suite 1217 San Jose, California RE: July 2011 Compliance Reports Dear John: This letter, in conjunction with the enclosed reports summarizes the EMS system performance for the month of July. Two points of explanation are necessary related to the total number of transports and the total number of patients as outlined in the Santa Clara Daily Transports Report: 1. The total number of transports is a representative number of the total number of ambulances that transported patients to hospitals. This number is not an actual patient count and does not include patient transports from the Palo Alto Exclusive Operating Area within Santa Clara County, out-ofcounty mutual aid responses, or special events. 2. The total number of patients is a representative number of the total number of patients transported to hospitals in ambulances. The variance from the number of total transports is accounted for when non-captured patient transports outlined in Item 1 above are considered in addition to multiple patients transported in the same ambulance from the same response address. We will continue to work with FirstWatch and the County to map the recently identified CAD fields that are not properly populating for those responses where available and reassignment times are not currently captured. Should you have any questions or concerns, please feel free to contact me at any time. Sincerely, Chad Henry Clinical Operations Manager Santa Clara County EMS Rural/Metro Ambulance of California 98

99 Rural Metro Santa Clara Compliance Summary Report Period: 7/1/2011 thru 7/31/2011 RLS NonRLS Total Grand Totals All Zones Total Zone 1 Zone 2 Zone 3 Zone 4 Zone 5 Total Responses 5,878 1,016 1,181 1,683 1, Late Responses Unadjusted Compliance 88.35% 82.48% 87.72% 91.68% 88.42% 90.93% Exemptions Requested Exemptions Granted GPS Verified Time Correction Adjusted Late Responses Adjusted Compliance 91.19% 85.14% 91.28% 94.12% 91.13% 94.40% Extended Minutes 214,573 49,500 39,447 56,339 54,120 15,167 Compliance Fine $194,500 $52,500 $42,000 $37,500 $55,500 $7,000 Dry Runs 1, Cancelled - On Time Cancelled - Late Total Responses 2, Late Responses Unadjusted Compliance 93.10% 93.65% 91.95% 93.49% 92.57% 97.75% Exemptions Requested Exemptions Granted GPS Verified Time Correction Adjusted Late Responses Adjusted Compliance 94.75% 95.04% 93.87% 94.54% 94.67% % Extended Minutes 79,980 21,120 22,360 13,551 22, Compliance Fine $67,000 $11,000 $18,500 $10,000 $27,500 $0 Dry Runs Cancelled - On Time Cancelled - Late Total Responses 7,994 1,520 1,703 2,159 2, Late Responses Unadjusted Compliance 89.60% 86.18% 89.02% 92.08% 89.43% 92.24% Exemptions Requested Exemptions Granted GPS Verified Time Correction Adjusted Late Responses Adjusted Compliance 92.13% 88.42% 92.07% 94.21% 91.99% 95.47% Extended Minutes 294,553 70,620 61,807 69,890 76,917 15,319 Compliance Fine $261,500 $63,500 $60,500 $47,500 $83,000 $7,000 Liquidated Damages $0 Total Fines $261,500 Dry Runs 1, Cancelled - On Time Cancelled - Late Printed on Page 1 of 1 99

100 Rural Metro Santa Clara Daily Transports 07/01/2011 to 07/31/2011 Incident Date # of Transports # of Patients 07/01/ /02/ /03/ /04/ /05/ /06/ /07/ /08/ /09/ /10/ /11/ /12/ /13/ /14/ /15/ /16/ /17/ /18/ /19/ /20/ /21/ /22/ /23/ /24/ /25/ /26/ /27/ /28/ /29/ /30/ /31/ Grand Total 5,556 5,