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WI LLIAMB.WA LKER,M.D.HEALTH SERV ICES DIRECTORARTfLATHROPEMS DIRECTOR.J os EP H BARGER,CONTRA COSTA/EMERGENCY, l R, L SERVICESM.D.J.II EDICAL DIRECTORC 0 N T RA C 0 S T AHEALTH SERVICESa,I 13 i Q.If D.!iive, Suite 126 # artiifez, California94553-1631Ph (925) 646-4690Fax (925) 646-4379December 24, 2007Cesar A. Aristeiguieta, MDEmergency Medical Services Authority1930 9th Street, Suite 100Sacramento, CA 85814-7043Attn: Sandy Salaber)Enclosed please find a copy of the Contra Costa County EMS System Plan annual updatefor 2006. The Timeline and Actions to be Addressed, and Specific Objectives sections areslate for approval by the Emergency Medical Care Committee on March 12, 2008. Anychanges to the objectives will be submitted following the EMCC meeting.Thank you for your clarifications of grandfathering and exclusivity in your December 20,2006 letter. Moraga Orinda Fire Protection District meets both the grandfatheringprovisions of H & SC Section 1797.201 as well as the exclusivity provisions of H & SCSection 1797.224.If you have any questions or require further information, please do not hesitate to call meat the Contra Costa EMS Agency. I am happy to report that we are well on our way indeveloping our EMS Plan update for 2007.Sincerely,v!,./ · ,')··hfJJ f) rrI ll i / · ll . l / 9 '· 1' / }i]{ltlll lr l,[uv!NJ/)Lauren KovaleffEMS Asst. Director)cc: Art Lathrop, EMS DirectorWilliam B. Waker, MD, Health Services Director Contra Costa Alcohol and Other Drugs Services Contra Costa Emergency Medical Services Contra Costa Environmental Health Contra Costa Health Plan Contra Costa Hazardous Materials Programs Contra Costa Mental Health Contra Costa Public Health Con tra Costa Regional Medical Center Contra Costa Health Centers

C 0 N T RA C 0 S T AHEALTH SERVICESEmergency Medical Services Agency)EMS Plan Annual Update2006/2007November 20071340 Arnold Drive, Suite 126Martinez, CA 94553(925) 646-4690 fax (925) 646-4379www.cccems.org

TABLE OF CONTENTSTABLE OF CONTENTS . . . . . i') SECTION I: SUMMARY OF CHANGES TO EMS PLAN. ISECTION II: UPDATES OF SPECIFIC INFORMATION . 2EMSA TABLE 2- System Organization and Management . 2EMSA TABLE 3- Personnel/Training . 6EMSA TABLE 4- Communications . 7EMSA TABLE 5- Response/Transportation . 7EMSA TABLE 6- Facilities/Critical Care . 9EMSA TABLE 7 - Disaster Medical . 9EMSA TABLE 8 - Providers . 11EMSA TABLE 9- Approved Training Programs . 15EMSA TABLE 10- Facilities. 17EMSA TABLE 11 -Dispatch Agencies . 20))SECTION III: PROGRESS FROM PREVIOUS YEAR . 21EMSA TABLE 1: SUMMARY OF SYSTEM STATUS . 21A.System Organization And Management .21B.Staffing/Training . 22C. Communications . .22D. Response/Transport ation . 23E. Facilities/Critical Care .24F. Data Collection/System Evaluation. 24G. Public Information And Education . 25H. Disaster Medical Response . 25COMPLETED ASSESSMENT FORMS . 26A.System Organization and Management .:. 26B.Staffing and Training . 32C. Communications . 34D. Response and Transportation . 37E. Facilities and Critical Care . 41F.Data Collection and System Evaluation .44G. Public Information and Education .-. 47H. Disaster Medical Response . 48MAJOR SYSTEM CHANGES . ,. 53SPECIFIC OBJECTIVES . ,. 55TIMELINE/ACTIONS TO BE ADDRESSED . 51ORGANIZATIONAL CHART . ,. 58AMBULANCE ZONE SUMMARY FORM- ERA I . 59AMBULANCE ZONE SUMMARY FORM- ERA ll . 60AMBULANCE ZONE SUMMARY FORM- ERA ill . 61AMBULANCE ZONE SUMMARY FORM- ERA IV. 62AMBULANCE ZONE SUMMARY FORM- ERA V . 63

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SECTION 1: SUMMARY OF CHANGES TO EMS PLAN)In 2004 the EMS Agency implemented a comprehensive EMS system redesign, major objectives being to increaseparamedic first responder staffing levels in fire services at no additional cost to the County, and to integrate new standards forrapidly providing ALS level care to patients. Projects designed to support full implementation of the EMS system redesigncontinue to be a major focus. The number of fire first responder paramedic units planned is 48 throughout the county. Thisnumber has increased from 38 to 41 fire first responder paramedic units during the past year. The EMS Agency has addedadditional staff to support an expanded quality improvement program and to support the Fire EMS Training Consortium, whichdevelops and coordinates standardized high-quality training modules for use countywide.A revised multicasualty incident plan, developed by a multidisciplinary ad hoc committee of experts and approved by theEmergency Medical Care Committee was implemented in July 2007. Training modules for all levels of participants weredeveloped and made available. Triage tags were purchased for ambulance and fire first responder agencies to providestandardization.))A-- -- CONT RA COST AHEALTHffi\Tic1sEMS SYSTEM PLAN- UPDATE FOR 06/071

MAJOR SYSTEM CHANGES)EMS SYSTEM MANAGEMENT AND ORGANIZATIONEMS Agency staff functions and assignments have been evaluated and consolidated in light of Plan priorities andgoals. Additional staff has been recruited to support Agency activities specific to EMS system Quality Improvementactivities.Integration of paramedic first responder and ambulance services continues to be a major priority in implementing acomprehensive plan approved by the Board of Supervisors in May 2004,for the integration of paramedic first responder andambulance services in those areas of the county covered by private ambulance services. The standard set for EMSresponses within Contra Costa County is a paramedic on scene within 10 minutes, either on the fire first responder unit, aparamedic-staffed "Quick Response Vehicle" (QRV), or the transport ambulance. All ambulances crews include at least 1 paramedic. The number of fire paramedic first responder units has increased from 38 to 41 of 48 planned fire first responderparamedic units during the past year. Four QRVs are located in areas throughout the county to provide or enhance a paramedic response.STAFFING AND TRAININGAt the request of the EMS chiefs, an EMS Training Consortium that includes representatives from each of the fire firstresponder agencies, emergency ambulance providers and EMS has been developed and implemented. The goal of theConsortium is to standardize EMS training throughout the county by working together on developing training plans,providing training aids, and encouraging participation by both public and private personnel working together. Fire providershave taken responsibility for further program development, although EMS Agency continues to provide staff support. A numberof training modules are being developed and are or will be available to all fire and ambulance agencies. Two human patientsimulators, one an adult (MetiMan) and the other, a child, along with related components have been purchased for use on arotating basis by fire agencies countywide.)COMMUNICATIONSInitiated construction of interoperable communications within the local health care system by adding hospitals andcommunity clinics to the County's new 440 mhz trunked radio system.RESPONSE AND TRANSPORTATIONSignificant time and effort has been spent reviewing and re-evaluating the model used for response to emergencymedical requests. In cooperation with the EMS Agency, local fire first-responder agencies continue to expand firstresponder advanced life support programs. Changes in ambulance staffing configuration and response time standards havebeen implemented in areas with fire paramedic first responder services.Local EMS aircraft policies and procedures for classification, authorization, request for, transport criteria and fieldoperations have been implemented. Two currently classified and accredited air medical providers are based within County.FACILITIES AND CRITICAL CARENine acute care hospitals currently provide Basic Emergency Medical Services. The ninth facility, Kaiser MedicalCenter, Antioch, opened in November 2007.DATA COLLECTION AND SYSTEM EVALUATIONAmerican Medical Response, the County's largest contract emergency ambulance provider, uses an electronic patientcare reporting system that is linked to their dispatch data. The patient care report (PCR) is printed at the patient's receivinghospital and specified data points are entered into a database. This information is used for a variety of functions includingquality improvement activities by designated EMS staff.Fire agencies providing paramedic ambulance and first responder services have implemented to varying degrees asimilar electronic PCR system to replace existing electronic and paper systems. This software was purchased by the EMSAgency for all fire agencies, and work was completed to tailor the system to meet local needs. This system ----------------- 52EMS SYSTEM PLAN- UPDATE FOR 06107CONTR A COSTASE.RV(CE SHEALTH

implemented in early 2007 by most agencies, however work continues to fully integrate this system within some agenciesand within the EMS system as a whole.PUBLIC INFORMATION AND EDUCATIONEMS Agency staff has initiated plans to increase awareness of its Public Access Defibrillation (PAD) program andencourage expansion of the program. American Medical Response, through its contract with the county provides certainpublic information and education activities on an annual basis. These activities include placement of 25 public accessdefibrillators, 25 CPR class for the public, and an EMS research project to improve care for citizens of the county.DISASTER MEDICAL RESPONSEDisaster planning continues to be a high local priority. EMS Agency staff members participate on the Health ServicesBioterrorism Response Planning Committee that provides education and training on biological threats for emergencyresponders, clinicians, and the public.County and other organizations have been involved in the preparation of several grant applications related tobioterrorism and homeland security. Hospitals in the county will receive funding to purchase personal protective equipmentfor treatment teams and decontamination units through a grant administered by the federal Health Resources and ServicesAdministration (HRSA) through the State EMS Authority. A federal Homeland Security grant administered through StateOES will continue to provide funding to Contra Costa fire, law enforcement, and health services for equipment purchases,planning, and exercises. EMS staff has successfully completed NIMS courses IS-00100, IS-00200, lS-00700.))- CONTR A COSTAHiii LT H SERVJC!SEMS SYSTEM PLAN- UPDA TE FOR 0610753

SPECIFIC OBJECTIVESProgress From Last Reporting MSA StructureYesRecruit additional staff to work with the expanding 1stresponder paramedic program and data management.Objective met. Prehospital Care Coordinator hired to be responsible for EMS system QualityImprovement Program.1.15Compliance WithSystem PoliciesYesReview and update local ambulance ordinance.Objective not met. 3 - 5 year project.1.18QA/QIYesExpand current Ql committee to includerepresentatives from all EMS and dispatch providers.Objective partially met. Ql Committee continues to meet, and anticipates that data from allprehospital providers should be a .vailable by early 2007, providing a major enhancement forCommittee capabilities. Planned membership expansion has not yet occurred.Further implement electronic capture of patient caredata within all first responder fire agencies.Objective partially met. Electronic PCR and data collection system implemented by most firefirst responder agencies. Full implementation planned by mid 2008.Further integrate electronic data to provide expandedcapability for EMS system evaluation.Objective partially met. Groundwork to provide individual provider data linkage continues tobe developed. Generally response time data is available, but the addition of patient caredata is being addressed.1.27Pediatric SystemPlanYesEvaluate current pediatric system plan and makechanges if indicated.Objective partially met. EMS staff is working with staff in nearby counties to explore ways toregionalize some services. Update of EMSC Plan will be undertaken as new State PlanGuidelines become available.2.01Assessment ofNeedsYesFurther develop and implement fire/EMS TrainingConsortium projects.Objective met. Fire EMS Training Consortium structure in place. Fire providers have takenresponsibility for further program development. EMS Agency provides staff support.2.05First ResponderTrainingYesFurther develop and implement fire/EMS TrainingConsortium projects to help standardize trainingactivities.Objective met. EMS staff is supporting a Fire EMS Training Consortium that is establishingEMS training standards and capabilities for use in fire agencies throughout the County. Twohuman simulators have been purchased (1 adult/1 child) to enhance the training capabilities.2.06ResponseYesWork with interested fire first responder agencies toincrease numbers of paramedics on first-responseunits.Objective largely met. The number of fire first responder paramedic units planned is 48throughout the county. This number has increased from 38 to 41 fire first responderparamedic units during the past year.5.05Mass CasualtyManagementYesComplete work on surge capacities for hospitals.Objective met. Surge Plan submitted to EMSA.5.10Pediatric SystemDesignYesParticipate in addressing regional planning efforts.Objective met. EMS Agency staff actively participates in regional planning ----------------------------------------------- 54EMS SYSTEM PLAN- UPDATEFOR06/07CON TRA COS TAHIHi'HsER.VTcB---

6.01QA/QI ProgramYesRequest EMS provider agencies to submit Ql Plans forapproval by the local EMS Agency pursuant to Title22, Chapter 12. (Directed by EMSA as part of it'sreview of CCC EMS System Plan)Objective partially met. Written Ql Plans have been requested of EMS provider agencies.EMS Agency staff in conjunction with the EMS Ql Committee has developed a number oftools/templates for provider agencies to use to develop or enhance written Ql plans, and isactively working with all providers to provide assistance.6.02PrehospitalRecordsYesImplement an electronic record and data collectionsystem in fire services countywide.Objective partially met. An electronic patient care documentation and data collection systemwas purchased for each fire first responder agency within the county. Initial implementationof the system occurred in January 2007. Some agencies are further along than others withfull implementation. The EMS Agency has contracted with an individual to work with the firstresponder agencies and EMS staff to further integrate use and accessibility.6.03Prehospital CareAuditsYesComplete a plan for routine and special auditsObjective partially met. Work continues on an expanded data management system thatshould provide greatly enhanced capability in this area. Individual ambulance and someparamedic first responder agencies perform both routine and special audits of prehospitalcare provided. EMS Agency staff routinely performs special audits of response time andemergency care provided on data available.6.05Data ManagementSystemYesContinue to work on implementation of an integrateddata management system.Objective partially met. Prehospital patient care data is currently available for approximately95% of ambulance responses, and all critical trauma patients. With the implementation of anelectronic patient care data system by early 2007, this number should reach 100%.A new system, FirstWatch, has been implemented in each of fire medical dispatch center,and work is being done to have the system installed in the private ambulance providersystem that can integrate response times and key clinical data. The plan is to add the patientcare data and the trauma registry data to this system that will provide a major linkage.6.09ALS AuditYesContinue to work on integrating first responder andreceiving hospital data.Objective partially met. See Objective 6.5 for update.8.02Response PlansYesComplete the review and revision of the current localMCI plan to assure that the broadest possible scope ofresponse possibilities is covered.Objective met. A revised MCI plan has been implemented countywide on July 1, 2007.Training programs for fire, ambulance, police, hospitals and EMS were developed andprovided to all system participants.8.01Disaster MedicalTrainingYesEMS Agency staff is required to successfully completethe National Incident Management system (NIMS)Training courses IS-00100, IS-00200, IS-00700.Objective met. EMS Agency staff has successfully complete the National IncidentManagement system (NIMS) Training courses IS-001 00, IS-00200, p a local ReddiNet polling and status drillprocedure with the hospitals.Objective partially met. Updated ReddiNet system implemented countywide. Polling andstatus drill procedure with hospitals in the planning stages.CON TRA COSTAHTATT H"Ti 1\v leiSEMS S YSTEM PLAN- UPDATE FOR 0610755

TIMELINE/ACTIONS TO BE ADDRESSEDAll State standards have been met. We plan to address or reassess the following dcrd1.15Compliance With System PoliciesYesReview and update local ambulance ordinance.3-5 years1.18QA/QIYes1) Expand Ql committee to include representatives from all EMS providers. 2) Further implement electronic patientcare data capture within the fire agencies. 3) Further integrate electronic data to expand system evaluation capability.1- 2 years1.27Pediatric System PlanYesEvaluate current pediatric system plan and make changes if indicated based on new State standards when available.2-3 years2.06ResponseYesContinue to work with interested fire first responder agencies to increase numbers of paramedics on first-response units.2-3 years3.01Communications PlanYesContinue to build interoperable communications within the health care system by adding hospitals and communityclinics to the County's new 440 mhz trunked radio system.1-2 years3.05HospitalsYesDevelop and implement monthly drill program to assure that emergency department, dispatch and EMS staff areproficient in using the ReddiNet system including the multicasualty and hospital polling processes.1 Year5.06Hospital Evacuation PlanYesReview hospital evacuation plans and participate in at least one tabletop exercise involving a hospital evacuation.1 -2 years5.08Trauma PlanningYesAddress supplemental issues raised by EMSA based on its review of the local Trauma System Plan. The TraumaPlan was approved by EMSA in 2003.1 year5.10Pediatric System DesignYesParticipate in addressing regional planning efforts.Ongoing5.13Specialty System DesignYesDevelop a STEM I system for Contra Costa1-2 years5.14Public InputYesAssure public input on the STEM I system design1 -2 years6.01QA/QI ProgramYesRequest EMS provider agencies to submit Ql Plans for approval by the local EMS Agency pursuant to Title 22,Chapter 12. (Directed by EMSA as part of it's review of CCC EMS System Plan)1 -2 years6.02Prehospital RecordsYesImplement and fully integrate an electronic record and data collection system in fire services countywide.1 -2 years6.03Prehospital Care AuditsYesComplete a plan for routine and special audits2- 3 year6.05Data Management SystemYesContinue to work on implementation of an integrated data management system.1 - 2 years6.09ALS AuditYesContinue to work on integrating first responder and receiving hospital data.2- 3 years7.01Public EducationYesEnhance awareness and expand PAD program2-3 years8.14Hospital PlansYesAssure that hospital fatality management plans are integrated into the County's plan for handling mass fatalities andconduct a tabletop exercise involving hospitals and appropriate local officials.1 -2 years8.15Inter-hospital CommunicationsYesDevelop a local ReddiNet polling and status drill procedure with the hospitals.1 ---------------------------------------- 56EMS SYSTEM PLAN- UPDATE FOR 06/07CONTRA CO ST AHt: i r fl-sn:vicrs---

ORGANIZATIONAL CHARTContra Costa Health Services, Emergency Medical Services-- --------------------------------------- .QlLLM.S:.9jiLHE AlTH SE RV ICESEMS SYS TEM PLAN - UPDATE FOR 0610757

SECTION Ill: PROGRESS FROM PREVIOUS YEAR)!EMSA TABLE 1: SUMMARY OF SYSTEM STATUSA.System Organization And ManagementDoesn't meetstandard).--")Meets minimumstandardAgency Administration1.01 LEMSA Structure1.02 LEMSA Mission1.03 Public Input1.04 Medical DirectorPlanning Activities1.05 System Plan1.06 Annual Plan Update1.07 Trauma Planning1.08 ALS Planning1.09 Inventory of Resources1.10 Special Populations1.11 System ParticipantsRegulatory Activities1.12 Review & Monitoring1.13 Coordination1.14 Policy/Procedures Manual1.15 Compliance w/PoliciesSystem Finances11.16 Funding MechanismMedical Direction1.17 Medical Direction1.18 QA/QI1.19 Policies, Procedures, ProtocolsMeets guidelinesrecommended Short-range Plan Long-range n/an/aXn/aXXXn/aBeing addressed.1.20 DNR1.21 Determination of DeathXXXX1.22 Reporting of AbuseXXX1.23 lnteriacility TransferEnhanced Level: Advanced Life SupportX1.24 ALS SystemX1.25 On-Line Medical DirectionEnhanced Level: Trauma Care SystemX11.26 Trauma System PlanEnhanced Level: Pediatric Emergency Medical and Critical Care SystemX11.27 Pediatric System PlanEnhanced Level: Exclusive Operating AreasX11.28 EOA PlanIII- IICONTRA COST A - - - - - - - - - - - -----------EMS SYSTEM PLAN- UPDATEFOR06!0721

B.)Doesn't meetstandardMeets minimumstandardMeets 10 Advanced Life SupportXXn/aNot planned.Enhanced Level: Advanced Life Support2.11 Accreditation Process2.12 Early Defibrillation2.13 Base Hospital PersonnelXXXn/an/an/aLocal EMS Agency2.01 Assessment of Needs2.02 Approval ofTraining2.03 PersonnelI)Staffing/TrainingDispatchers2.04 Dispatch TrainingFirst Responder (non-transporting)2.05 First Responder Training2.06 Response2.07 Medical ControlTransporting Personnel2.08 EMT-1 TrainingHospital2.09 CPR TrainingC.Doesn't meetstandardCommunications Equipment3.01 Communications Plan3.02 Radios3.03 lnterfacility Transfer3.04 Dispatch Center3.05 Hospitals3.06 MCI/DisastersPublic Access1 3.o7 9-1-1 Planning/Coordination1 3.o8 9-1-1 Public EducationResource Management3.09 Dispatch Triage3.10 Integrated DispatchShort-range PlanLong-range PlanIIXXICommunicationsMeets minimumstandardXXXXXXXXXXMeets guidelinesrecommendedShort-range PlanLong-range --------------------------------------- --CO NTRA COST AEMS SYSTEM PLAN- UPOATE06!0722Hf!.f Hf s·Ei\VitfS

D.Response/Transportation)Doesn't meetstandardUniversal Level4.01 Service Area Boundaries4.02 Monitoring4.034.044.054.064.074.08Classifying Medical RequestsPre-scheduled ResponsesResponse Time StandardsStaffingFirst Responder AgenciesMedical & Rescue AircraftMeets minimumstandardMeets guidelinesrecommendedXXXXXXXXXXn/an/aShort-range PlanUpdate planned.Being addressed.n/an/an/a4.09 Air Dispatch Center4.10 Aircraft AvailabilityXXn/an/a4.11 Specialty Vehicles4.12 Disaster ResponseXXn/an/a4.13 Intercounty ResponseXX4.14 Incident Command SystemXn/aXnfaXXXn/aIIIIXn/aIXXn/an/aXXn/an/a4.15 MCI PlansEnhanced Level: Advanced Life Support14.16 ALS Staffing14.17 ALS EquipmentEnhanced Level: Ambulance RegulationI 4.18IComplianceEnhanced Level: Exclusive Operating Permits4.19 Transport Plan4.20 "Grand fathering"4.21 Compliance4.22 EvaluationLong-range PlanIIII .h9.J'!J &t\ . QS IA.HEAlT H SERV I CE SEMS SYSTEM PLAN- UPDATE FOR 0610723

E.Doesn't meetstandardUniversal Level5.01 Assessment of Capabilities5.02 Triage & Transfer Protocols5.03 Transfer GuidelinesFacilities/Critical CareMeets minimumstandardMeets guidelinesrecommendedXXXBeing addressed.Short-range PlanLong-range Plann/an/a5.04Specialty Care FacilitiesXn/a5.05Mass Casualty ManagementXX5.06Hospital EvacuationXn/aOngoingEnhanced Level: Advanced Life SupportX5.07 Base Hospital DesignationEnhanced Level: Trauma Care SystemX5.08 Trauma System DesignX5.09 Public InputEnhanced Level: Pediatric Emergency Medical and Critical Care SystemX5.10 Pediatric System Design5.11Emergency Departments5.12 Public InputsEnhanced Level: Other Specialty Care Systems15.13 Specialty System Design\. 15.14 Public Inputn/an/an/aXXOngoingXn/aXn/aXXn/an/alF.Data Collection/System EvaluationDoesn't meetstandardUniversal Level6.01 QA/QI Program6.02 Prehospital Records6.03 Prehospital Care Audits6.04 Medical Dispatch6.05 Data Management System6.06 System Design EvaluationMeets minimumstandardXXXXXXMeets guidelinesrecommendedShort-range PlanLong-range PlanXn/an/a.n/aBeing addressed.XXn/a6.07Provider ParticipationXn/a6.08ReportingXn/aXBeing addressed.Xn/aXXEnhanced Level: Advanced Life SupportIj6.09 ALS AuditEnhanced Level: Trauma Care System6.10 Trauma System Evaluation6.11Trauma Center -------------------- 24EMS SYSTEM PLAN· UPDATE06107i-/l tN {it'tiHs---

G.)Public Information And EducationDoesn't meetstandardUniversal Level7.01 Public Information Materials7.02 Injury Control7.03 Disaster Preparedness7.04 First Aid & CPR TrainingH.Universal LevelDisaster Medica

The ninth facility, Kaiser Medical Center, Antioch, opened in November 2007. DATA COLLECTION AND SYSTEM EVALUATION . 25 CPR class for the public, and an EMS research project to improve care for citizens of the county. DISASTER MEDICAL RESPONSE