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HomeMy WebLinkAbout2018-alameda-emsplanSTATE OF CALIFORNIA —HEALTH AND HUMAN SERVICES AGENCY GAVIN NEWSOM, Governor EMERGENCY MEDICAL SERVICES AUTHORITY 14901 GOLD CENTER DR., SUITE 400 RANCHO CORDOVA, CA 95670 (916) 322-4336 FAX (916} 322-1441 January 2, 2020 Ms. Lauri McFadden, EMS Administrator Alameda County EMS Agency 1000 San Leandro Boulevard, Suite 200 San Leandro, CA 94577 Dear Mr. McFadden: This letter is in response to Alameda County's 2018 EMS Plan submission to the EMS Authority on November 18, 2019. I. Introduction and Summary: The EMS Authority has concluded its review of Alameda County's 2018 EMS Plan and is approving the plan as submitted. II. History and Background: Alameda County received its last plan approval for its 2017 plan submission. Historically, we have received EMS Plan submissions from Alameda County for the following years: • 1995 2007 • 1999 2009-2011 • 2004 2014-2017 Health and Safety Code (HSC) § 1797.254 states: "Local EMS agencies shall annually (emphasis added) submit an emergency medical services plan for the EMS area to the authority, according to EMS Systems, Standards, and Guidelines established by the authority". The EMS Authority is responsible for the review of EMS Plans and for making a determination on the approval or disapproval of the plan, based on compliance with statute, regulations, and case law, consistent with HSC § 1797.105(b). Ms. Lauri McFadden, EMS Administrator January 2, 2020 Page 2 of 3 III. Analysis of EMS System Components: Following are comments related to Alameda County's 2018 EMS Plan. Areas that indicate the plan submitted is concordant and consistent with applicable laws, regulations, case law, and the EMS system components identified in HSC § 1797.103, are indicated below: Not Approved Approved A. ~ q System Organization and Management B. ~ q Staffing/Training C. ~ q Communications D. ~ q Response/Transportation Ambulance Zones Based on the documentation provided, please find enclosed the EMS Authority's determination of the exclusivity of Alameda County's ambulance zones. E. ~ q Facilities/Critical Care F. ~ q Data Collection/System Evaluation G. ~ q Public Information and Education H. ~ q Disaster Medical Response IV. Conclusion: Based on the information identified, Alameda County's 2018 EMS Plan is approved. Pursuant to HSC § 1797.105(b): "After the applicable guidelines or regulations are established by the Authority, a local EMS agency may implement a local plan...unless the Authority determines that the plan does not effectively meet the needs of the persons served and is not consistent with the coordinating activities in the geographical area served, or that the plan is not concordant and Ms. Lauri McFadden, EMS Administrator January 2, 2020 Page 3 of 3 consistent with applicable guidelines or regulations, or both the guidelines and regulations established by the Authority." V. Next Steps: Alameda County's next EMS Plan will be due on or before December 31, 2020. If you have any questions regarding the plan review, please contact Ms. Lisa Galindo, EMS Plans Coordinator, at (916) 431-3688. Sinc , f om McGi nis, EMT-P Chief, EMS Systems Division Enclosure nri v C) C~ C~ C) ~ oo ~. D D ~~ ~ ~ o 0 0 0~ c~ o~~ c~i ~ o~ D D ° ~ ~' ~ Q- r"~-~~ 3 z~~o n <' 3~~ ~ c~ v Q 3 c c O 3 0 °~ rnri v~ ~ m co ~ D x Z cu7 6 C) N (np j Q ~ ~. (fl Non-Exclusive x x x x x Exclusive m x z z z z ~ ~ 0 ~ 0 ~ 0 ~ 0 ~ n c cn m ~ ~ o ~ 0 ~ 0 ~ 0 a ~ Method to Achieve ~ ~ ~ ~ ~ `D Exclusivity ~ ~ c~— coo — m — cn — <~ ~ <' co <' cn <' cu <' cu x x x x x Emergency Ambulance ALS m LALS All Emergency Ambulance Services X X X X x 9-1-1 Emergency Response 7-digit Emergency Response m x ALS Ambulance m All CCT Ambulance ~ Services BLS Non-Emergency and IFT Standby Service with X Transport Authorization N 0 —~ D ~ 3 V~ N ~ Q O v v n o o c ~ ~ C~ `~ yo m ~ ~ ~ ~~ ~ a o ~ c~ m ~ v Q~~ ~,E Q ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY j Emergency Medical Services District i ^r 1000 San Leandro Blvd, Suite 200 `~ +°~• San Leandro, CA 94577 yEOI ~~ September 27, 2019 David Duncan, MD Director California Emergency Medical Services Authority 10901 Gold Center Drive, Suite 400 Rancho Cordova, California 95670 Dear Dr. Duncan, Colleen Chawla, HCSA Director Lauri McFadden, EMS Director Karl Sporer, MD, Medical Director Main: (510) 618-2050 Fax: (510) 618-2099 Attached please find the 2018 Alameda County EMS Plan Update (Update). This Update depicts those changes that have transpired within the Alameda County EMS system since our last submission. The California Emergency Medical Services Authority (EMSA) approved the Alameda County EMS Plan last year. This Update combined with prior submitted documents describes our EMS system at the present time. Alameda County EMS Agency's principle objective continues to be ensuring the financially sustainable provision of high-quality emergency medical services that are efficient and effective both clinically and operationally. To this end, the County completed a Request for Proposal process at the end of 2018 with Falck Northern California succeeding Paramedics Plus as the new 9-1-1 ambulance transport provider for our exclusive operating area (EOA) as of July 1, 2019. Thank you in advance for your review of this Update. As always, please do not hesitate to contact me if you have any questions or require additional information. Respectfully, Lauri McFadden Director, Emergency Medical Services Attachment cc: Colleen Chawla, HCSA Director Karl Sporer, EMS Medical Director William McClurg, EMS Deputy Director Galindo, Lisa@EMSA From: McFadden, Lauri, EMS <Lauri.McFadden@acgov.org> Sent: Friday, December 13, 2019 1:47 PM To: Galindo, Lisa@EMSA Cc: McClurg, William, EMS; Sporer M.D., Karl, EMS Subject: System Plan Updates Attachments: Patient Care Policies and Procedures Letter -December 2019.pdf Hi Lisa, Thanks for the phone call yesterday. Now for follow-up... sent you email already regarding the training and CE programs and I got your response. Jim Morrissey is our MHOAC and he works here at the Alameda County EMS Agency as a Supervising Prehospital Care Coordinator. His office address is the same as mine (listed below). His cell phone number is 510-551- 3232. He works closely with all of the allied agencies involved with the creation and implementation of the Alameda County Emergency Operations Plan. Attached you will find the letter from our Medical Director regarding patient care policies and procedures. Please let me know if you need anything else from us. Happy Holidays! l~uri McFadden Dwrectar Alameda Counry EMS Agency 1000 San Leandro Blvd., Suite 200 San Leandro, CA 9+1577 Phone; 510-618-2055 Fax: 510-618-2099 Website: httpJ/ems.ac~~rV,ore Save the Date! EMSAAC Conference 5/27-5/28/2020 Omni San Diego Hotel ~, o A ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY Colleen Chawla, HCSA Director -__ —_ -- - P __.__. _.- .__.-___ _. ._ ._ _...._ Emergency Medical Services District Lauri McFadden, EMS Director Karl Sporer, MD, Medical Director a~ 1000 San Leandro Blvd, Suite 200 Main: [510) 618-2050 qc 4 San Leandro, CA 94577 Faac: (510) 618-2099 ~ y E i ~~ December 12, 2019 David Duncan, MD Director California Emergency Medical Services Authority 10901 Gold Center Drive, Suite 400 Rancho Cordova, CA 95670 Re: Patient Care Policies and Procedures Dear Dr. Duncan, Based on feedback we have received from your staff, I am writing to confirm that I am actively involved in creating and regularly updating our parient care policies, protocols, and procedures. Additionally, I have reviewed and approved all patient care policies, protocols, and procedures that are currently in place. Respectfully, Karl S er, MD Medical Director, Emergency Medical Services .,:~~~~ ALAMEDA COUNTY EMERGENCY MEDICAL SERVICES EMS SYSTEM PLAN 2018-19 EXECUTIVE SUMMARY SEPTEMBER 13, 2019 Executive Summary- Provide a brief overview of the ,clan. It should identify the major needs which have been found and a summary of the proposed program solutions. Include any changes which have occurred in your system, such as a change in providers, the designation of new centers, a change in key personnel, efc. EXECUTIVE SUMMARY SECTIONS SECTION 1 —EMS SYSTEM /PLAN OVERVIEW • PLAN APPROVALS • EMS SYSTEM VISION LEADERSHIP /ORGANIZATION • PERSONNEL REORGANIZATIONS • EMERGENCY PREPAREDNESS AND RESPONSE DEPLOYMENTS SECTION 2 -SYSTEM OPERATIONS AND REGULATORY COMPLIANCE -CHANGES AND UPDATES -' • EMERGENCY AMBULANCE SERVICES CONTRACTS • SYSTEM OPERATIONS; 911 REQUEST FOR PROPOSAL • 911 EMERGENCY AMBULANCE TRANSPORT PROVIDER TRANSITION UPDATE o EMS ZONES AND DEPLOYMENT AMBULANCE o EMS SYSTEM RESPONSES o DISPATCH PRIORITIZATION • HEALTH CARE SYSTEM OPERATIONS -CONTRACTS • EMS POLICY SECTION 3 -CLINICAL SYSTEMS OF CARE • SPECIALTY CENTERS -TRAUMA; STEMI; CARDIAC, PEDIATRIC RECEIVING CENTERS • SPECIALTY PROGRAMS -EXAMPLES • PUBLICATION -HIGHLIGHTS • HEARTSAFE PROJECT • CPR9 SECTION 4 - 2018-19 WORKPLAN • IDENTIFIED NEEDS, GOALS, AND SOLUTIONS o SYSTEM OPERATIONS AND REGULATORY REQUIREMENTS o CLINICAL SYSTEMS OF CARE o EMERGENCY PREPAREDNESS AND RESPONSE; o CAREER AND WORKFORCE DEVELOPMENT o EMS FOR CHILDREN AND INJURY PREVENTION Page 1 SECTION 1 —EMS SYSTEM /PLAN OVERVIEW EMS SYSTEM PLAN EMS PLAN -Division 2.5 of the California Health and Safety Code, Section 1797.254 states "Local EMS agencies shall annually submit an emergency medical services plan for the EMS area to the Authority, according to the EMS Systems, Standards, and Guidelines established by the Authority." The Alameda County EMS System Plan provides a comprehensive report with the required documentation for compliance with the California EMS regulations and guidelines. The EMS standards are met and in most cases exceeded relative to the requirements to ensure a quality EMS system. The responsibility of Alameda County EMS (ALCO EMS) for planning, implementing and evaluating the local EMS system is documented in this annual update report. Many of our responsibilities, and the authority needed to carry out our oversight role, are derived from Division 2.5 of the California Health and Safety Code, and related chapters of Title 22 of the California Code of Regulations. CA EMSA APPROVAL -SYSTEM PLANS AND REGULATORY COMPLIANCE EMS SYSTEM PLAN • Alameda County 2017 EMS System Plan Update (with 2017-2018 Executive Summary) completed approved by the California EMS Authority September 2018; 2018 Update submitted to EMSA September 2019 EMS TRAUMA PLAN • Alameda County 2017 EMS Trauma Plan Update submitted and approved by CA EMSA September 2018; Trauma 2018 Update submitted to EMSA September 2019 EMS QUALITY IMPROVEMENT (QI) AND COMMUNICATIONS PLAN • 2017 Update approved by CA EMSA September 2018; 2018 Updates submitted to EMSA September 2019 EMS SYSTEM VISION ALAMEDA COUNTY EMS VISION • VISION Helping people live healthy and fulfilling lives through training, preparedness, prevention, and medical response. • MISSION Alameda County EMS ensures the provision of quality emergency medical response services and prevention programs to improve health and safety in Alameda County. • VALUES Alameda County EMS values a caring environment sustained by empowerment, honesty, integrity and mutual respect. We embrace excellence through innovation, teamwork and community capacity building. • Alameda County EMS has adopted and continues to strive towards the National Highway Traffic Safety Administration (NHTSA) vision described in the "EMS Agenda for the Future." Refer to the vision below: • "Emergency Medical Services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers and public health and public safety agencies. It will improve community health and result in more appropriate use of acute health care resources. EMS will remain the public's emergency medical safety net." Page 2 EXECUTIVE SUMMARY -SECTION 1: EMS SYSTEM /PLAN OVERVIEW • A decade ago, the Institute of Medicine (IOM) released a report titled "EMS at the Crossroads" which accurately identified that "EMS operates at the intersection of health care, public health and public safety." Given the above vision and this reality, ALCO EMS leverages partnerships to attain effective outcomes. • Alameda County EMS facilitates collaboration with stakeholders and partners propagating a flexible system that continuously adapts to the changing healthcare environment. Alameda County EMS strives to deliver services that are consistent with the Institute for Healthcare Improvements "Triple Aim" of: o Improving the patient experience of care (including quality and satisfaction) o Improving the health of populations; and o Reducing the per capita cost of healthcare EMS LEADERSHIP —TEAM OF EXCELLENCE, VISION, INNOVATION, AND INCLUSIVENESS • The Alameda County EMS system has an innovative, highly skilled, and competent professional staff that demonstrates leadership and innovation with leading edge models, projects and programs that have enhanced prehospital care throughout California and the nation. Alameda County EMS has an integrated and collaborative team that recognizes the need for inclusive partnerships to leverage improvements and growth within the system. Alameda County EMS staff collaborates closely with EMS providers system-wide and with national experts to continually improve the EMS system by ensuring policy and program changes based on the analysis of the data submitted to ALCO EMS by its system's providers and on the evidence-based findings of current research studies. ALCO EMS continues to be a visionary leader and champion in local, regional and national EMS organizations. ALCO EMS provides oversight for all aspects of the EMS system in the County; to include monitoring dispatch centers, training center, first responder paramedic services, transporting ambulances, and receiving hospitals. ORGANIZATION • The Alameda County EMS system responds to approximately 160,000 patients annually for medical emergencies. The majority of 9-1-1 emergency medical calls in the County are responded to with the configuration of an Advanced Life Support (ALS) fire department first responder unit and a County contracted ALS ambulance. The fire departments of the cities of Alameda, Albany, Berkeley and Piedmont provide primary ALS ambulance transport services and first response within their respective incorporated areas. The Lawrence Livermore National Laboratory contracts with the Alameda County Fire Department for emergency medical services including ambulance transport. CHANGES, UPDATES, &MODIFICATIONS The Alameda County EMS agency has consistently adapted to ongoing changes influencing the health care delivery system throughout the United States over the years. Ambulance system economics remain under considerable strain, not only in Alameda County, but in many California counties and across America due to a marked decline in private and public reimbursements for services. With the evolving health care system, the Alameda County operational area EMS system remains effective and committed to excellence. The Health Care Services Agency and EMS, along with our hospital, clinic, Medi-Cal managed care plan and other system stakeholders and community partners continue to work together to remain informed at the national, state, regional and local levels regarding the implications of ongoing healthcare reform, collectively mitigating risks and acting upon opportunities to ensure the overall stability of the County's healthcare system. Page 3 EXECUTIVE SUMMARY —SECTION 1: EMS SYSTEM /PLAN OVERVIEW Alameda County hospitals and health systems continue to merge and reorganize. Alameda County EMS has the "pulse" on monitoring the changing landscape and continues to identify and act upon opportunities to strengthen the system in 2018-19. Alameda County EMS has and will continue to adapt with preemptive readiness and priority planning efforts to ensure continuity of overall system performance, including the effective management of potential and real prehospital / emergency department patient overload. ALCO EMS also continues to plan for contingencies and respond to continuously evolving threats including those related to unrest associated with the current national political climate, domestic and international terrorism, as well as natural and human-caused disasters. EMERGENCY PREPAREDNESS AND RESPONSE DEPLOYMENTS • Norther California Firestorm including Butte Camp Fire Response in 2018 - RDMHS Region II responded to and monitored activities relating to the catastrophic North Bay Fires that affected 5 OAs within region II, as well as the Camp Fire that affected Butte County in Region III. RDMHS Region II monitored the environmental extended response to the incident in Sonoma County. Alameda County EMS was honored in June 2019 for the coordination and response to the Butte Camp Fire -providing RDMHS support and relief in the Public Health DOC. EMS ORGANIZATIONS /STAFFING CHANGES —SYSTEM IMPACT AND BENEFITS EMS ROLES • ALCO EMS continues to utilize a functionally-based organization with the following organizational areas: System Operations and Regulatory Compliance; Emergency Preparedness and Response; Injury Prevention; Health Care Career/Workforce Development Programs; Finance/Administration. The EMS program scope includes community education, simple and complex training programs, incident planning and management, emergency dispatch standards, data collection, quality improvement, statute, policy and regulation enforcement, EMS personnel certification, investigations, management of specialty care programs including hospital-based specialty care components (i.e. Cardiac, Stroke, Trauma, and pediatrics), surge/disaster preparedness, development of innovative programs such as the Community Assessment, Treatment and Transport (GATT) Team to address the subset of patients coping with behavioral health and substance abuse issues, and hospital -EMS integration. • The EMS Deputy Director, EMS Medical Director and EMS Coordinators (previously classified as Pre-Hospital Care Coordinators) team provide essential support to the EMS Director. EMS ORGANIZATION • Alameda County EMS is a division of the Alameda County Health Care Services Agency (HCSA), organizationally positioned within the Office of the Agency Director. EMS DIRECTORS -Alameda County EMS promoted and hired directors and staff listed below • ANNE KRONENBERG joined EMS as the Interim Director (replacing Interim Director Aiello in October 2018) serving until April 8, 2019 when a permanent Director was hired. She is continuing with EMS as a consultant assigned to special projects to include disaster preparedness, emergency planning, and the next 9-1-1 ambulance RFP. • LAURI MCFADDEN, EMS Director, started April 8, 2019; she currently reports directly to Colleen Chawla, Agency Director, Health Care Services Agency. • WILLIAM MCCLURG (previously EMS Coordinator) was promoted to the EMS Deputy Director position May 19, 2019. Page 4 EXECUTIVE SUMMARY -SECTION 1: EMS SYSTEM /PLAN OVERVIEW RDMHS ARAM BRONSTON -started November 19, 2018 serving as the Regional Disaster Medical Health Specialist for Region II EMS COORDINATORS (previously Prehospital Care Coordinators, PHCCs) -New EMS Coordinators are listed below: • YOLANDA TAKAHASHI, started April 8, 2019 (Primary EOA Ambulance Transport Contracted Provider Liaison, CATT Team Implementation Project Lead) • LESLIE SIMMONS, started July 29, 2019 (Non-Emergency Permitted Ambulance Provider Liaison, Receiving Facility Liaison) INJURY PREVENTION • No Changes in Staff GENERAL ADMINISTRATION AND STAFFING • ERICA CAMPOS (Promotion from Specialist Clerk II to Secretary II) provides supervision and coordination of support staff as well as administrative support to the EMS Director, Deputy Director and Medical Director MICHELLE BARRIENTOS (Promotion from Specialist Clerk I to Specialist Clerk II) provides support to EMS agency staff particularly in the area of procurement and financial processing WILLIAM TUTOL (Hired as Administrative Specialist il) provides administrative and process management of contracts to include communications with County Board of Supervisors EMS ORGANIZATION CHANGES • Refer to EMS System Plan Table 2 -Organization Chart for staff positions and reporting relationships. EXECUTIVE SUMMARY -SECTION 2: SYSTEM OPERATIONS AND REGULATORY COMPLIANCE NEW CHANGES, UPDATES, 8 MODIFICATIONS AMBULANCE TRANSPORT SERVICES -EXCLUSIVE OPERATING AREAS • Alameda County is separated into five exclusive operating areas (EOAs) for the provision of 9-1-1 ambulance transport services. Within each EOA there is a contracted provider for 9-1-1 ambulance transport services. Four of the EOAs are contracted through anon-competitive grandfathering of existing services provided by municipal fire departments. These EOAs are the cities of Alameda, Berkeley, Albany, and Piedmont. The fifth EOA is served by a competitively bid provider and encompasses the remainder of the County with the exception of Lawrence Livermore National Labs which has a federal contract with Alameda County Fire District. The County's agreement for 9-1-1 ambulance service by Paramedics Plus to the County's exclusive operating area (EOA) ended June 30, 2019. ALCO EMS conducted a competitive bid process for the EOA, as approved by the California Emergency Medical Services Authority (EMSA), through which an independent review committee selected Falck Northern California as the successful bidder. • In December of 2018, Falck Northern California was contracted as the new provider to begin service on July 1, 2019 continuing through June 30, 2024. • On July 1, 2019 at midnight, Paramedics Plus ceased operations in Alameda County and Falck Northern California assumed the provision of 9-1-1 ambulance services within their contracted EOA. NEXT PAGE Page 5 EXECUTIVE SUMMARY —SECTION 2: SYSTEM OPERATIONS AND REGULATORY COMPLIANCE NEW CHANGES, UPDATES, 8 MODIFICATIONS EMERGENCY AMBULANCE SERVICES -CONTRACTS • Alameda County EMS continues to sustain and strengthen the 9-1-1 emergency ambulance services system through EOA contract management. Alameda County EMS is responsible for the procurement and provision of emergency ambulance services that includes contracts with Falck, and the cities of Alameda, Albany, Berkeley, and Piedmont for Advanced Life Support (ALS) services in Alameda County. The cities referenced above provide ambulance as well as first response ALS service. These cities provide ambulance services through their respective city fire departments. The termination dates of these contracts are June 30, 2024, each with an option to emend for an additional five (5) year period. • Berkeley Fire Department has subcontracted with Falck Northern California to supplement their ALS ambulances services with two (2) BLS ambulances, 24 hours a day, 7 days a week, in order to respond to behavioral health calls within their city. EMS SYSTEM EVALUATION AND REQUEST FOR PROPOSALS (RFP) ENSURES SYSTEM SUSTAINABILITY AND CONTINUITY The Alameda County EMS Agency actively conducted an Request for Proposal (RFP) approved by EMSA for 911 emergency ambulance services for the Exclusive Operating Area currently served by Falck (previously served by Paramedics Plus), with the goal of ensuring an EMS System that is clinically and operationally excellent as well as financially solvent: OVERARCHING GOALS • Sustain and improve quality of clinical care the patient receives • Stabilize or reduce the cost of EMS services (financial stability) • Improve patient satisfaction SIX FUNDAMENTAL TENANTS 1. Preserving a high level of emergency medical response throughout the County. 2. Producing a system that is cost-effective while preserving a high level of response and care. 3. Designing a system that is County-wide (i.e. Current Exclusive Operating Area (EOA) allowing for consistency of service throughout all areas and jurisdictions of the County). 4. Maintaining and supporting the current workforce. 5. Producing a system that is sustainable for the long term. 6. Maintaining appropriate regulatory and oversight functions between local EMS agency (LEMSA) and chosen provider(s). 911 REQUEST FOR PROPOSAL • Finalized and released EMSA approved Request for Proposal EMS-901017 for 911 Emergency Ground Ambulance Service with service to the County's EOA to begin July 1, 2019. Conducted two Bidder's Conferences to clarify key components of the RFP and answered bidder questions. Compiled additional bidder questions and answers into a master document and released as an addendum. Three bidders submitted proposals. Falck was selected for 911 ambulance service. NEXT PAGE Page 6 EXECUTIVE SUMMARY -SECTION 2: SYSTEM OPERATIONS AND REGULATORY COMPLIANCE NEW CHANGES, UPDATES, 8 MODIFICATIONS EMS SYSTEM EVALUATION AND REQUEST FOR PROPOSALS (RFP) RFP #EMS 901017 -SCHEDULE OF ACTIVITIES AND TIMELINE EVENT DATE/LOCATION Request Issued October 27, 2017 Letter of Intent Due November 29, 2077 by 2:00 p.m. Written Questions Due December 15, 2017 by 5:00 p.m. Networking/Bidders Conference #1 December 6, 2017 @ 2:30 p.m. Castro Valley Library, 3600 Norbridge Avenue, Chabot Room, Castro Valley, CA 94546 Networking/Bidders Conference #2 December 7, 2017 @ 2:30 p.m. Behavioral Health Care Services, 2000 Embarcadero Cove, Suite 400, Gail Steele/Alameda Room, Oakland Addendum #1 Issued November 15, 2017 Addendum #2 Issued December 13, 2017 Addendum #3 Issued January 19, 2018 Addendum #4 Issued April 9, 2018 Addendum #5 Issued May 11, 2018 Response Due July 18, 2018 by 2:00 p.m. Responses Opened and Announced in Public July 18, 2018 at 2:30 p. m. at 1000 San Leandro Blvd., 15' Floor, San Leandro, CA 94577 Evaluation Period July 19 -August 9, 2018 Bidder Interviews August 8-9, 2078 Board Letter Recommending Award Issued September 11, 2018 Board Consideration to Award Falck September 25, 2018 Board Award Date — Falck December 4, 2018 Contract Start Date October 1, 2018: Contractor began mobilization efforts to insure that it can begin service on service start date. Falck Contract Signed Date December 14, 2018 Transition Planning & Timeframe Six Months (Falck Position Interviews; identifying locations for deployment hubs); Purchase 77 ambulances Service Start Date 12:00 a.m. July 1, 2019 or immediately following the conclusion of the previous provider contract, if different from the service start date listed in the RFP. Contract End Date June 30, 2024 911 EMERGENCY AMBULANCE TRANSPORT PROVIDER TRANSITION • On December 4, 2018, the Alameda County Board of Supervisors approved an Agreement with Falck Northern California for the provision of 911 Emergency Ambulance Services for 5 years commencing July 1, 2019. • The normal timeframe fora 911 provider transition occurs over an 18 to 24-month period. Falck's transition into Alameda County is occurred over 6 months. Page 7 EXECUTIVE SUMMARY —SECTION 2: SYSTEM OPERATIONS AND REGULATORY COMPLIANCE EMS TRANSITION PLANNING • With the selection of the 911 ALS transport contract to Falck for July 1, 2019, there was significant planning, including o Designated EMS staff member as the point person for the transition planning; o Development of a Gant chart of deliverables; c Creation of appropriate committees with staff and membership; and o Falck leadership interviews with support of EMS. 2019 FALCK TRANSITION PLAN ~ ~ C ~ 'n C O D1 V d " ~ C u ~ ~ ~ ~ v c y i° v v c Y c ~ u o f0 u. ~ a°1, or E ~ ~ ~ °~' U ~ °1 , d °1 £ m a C o °' p) O OD O a J ~ C J .~- bG O O p~ Y ~ N n ~ ~~\ u m C oD O a ~ d tCa 7 W Y ~~ '~ t0 U1 y ~ O "O O G Al u ~ f0 ~ u ~n ~ ~ O d ~ !- ~ -+ io fp ~ p_ ~ Q o' oN' a O a > ~ r,,, d O " ~ > C v ~ O ~ ~v ai te ~` (~J a rm~ o x 3 y d v S v c v~ '° m a c Z' ~ ~r~ a~ ~~ d v °1 >~ v ~n ~ m ~o ~o 7 'm ~ N C~ ' c = Q~ > p 3 Q T u ~ ~ ~ o°o v a~i c c ~ o o u a Z W ~ • LL lL C 1' m Q t R D U W Y • Z W C C 3 • 4 U~ In Town Hall Meetin with Employees Falck Attending County Meetings CHP and EMS Inspections DEPLOYMENT ZONES —NEW CHANGE JULY 1, 2019 • Alameda County had previously been divided into 4 Deployment Zones for the Contracted County Private Provider EOA. Moving forward as of July 1, 2019, the zone configuration is changed to 3 Deployment Zones as pictured on the next page. This change aligns better with regional call volume and more importantly with geographical and infrastructure challenges that exist. The expectation is that the daily delivery of service of these zones meets the geographic, demand and community needs within each zone. • The previous process of shifting resources from one zone to another in order to meet demand created gaps in coverage, especially in Southern and Eastern Alameda County, and delayed responses into Northern Alameda County to include Emeryville and the busiest parts of Oakland. In this new system, the inter-zone movement of ambulances should be the exception rather than the rule. The ambulance posting plan and deployment schedule are crafted based on historical call data, the strategic placement of ambulances to maximize coverage, and the integration of additional ambulances into the system. NEXT PAGE Page 8 EXECUTIVE SUMMARY —SECTION 2: SYSTEM OPERATIONS AND REGULATORY COMPLIANCE 911 EMERGENCY AMBULANCE TRANSPORT PROVIDER TRANSITION These zone allocations are also a part of the response time measurement process in order to ensure the Contracted County Private Provider is meeting their 90% minimum obligation. Response times in each zone are determined by priority and population. This will also serve as an important performance metric, identifying if there is a need to allocate additional resources within a zone to provide the level of service dictated by demand and the community M f North Zone _ _ _-- - ------- _ _ __ "'^^•°~°°~^^~01~ 7eDulauan D~iulry Gbpvba Eme ille, Oakland, San Areas with 2,040 or more rn~ Leandro, San Lorenzo, residents per square mile _~_ Hayward and Castro Valley Suburban ~,~--~ South Zone ', ~ ~ Areas with 1,000 to 1,999 Union City, Fremont, residents per square mile L' _ ~ ~. Newark, and Sunol ,~ ~~ ~ Rural/Open Space ~~ East Zone ~-~^ ~~ ~ `-,. ".._~.,., Areas with 0 to 999 ~ ~. ______ Dublin, Pleasanton, residents per square mile I~ --=—'~ and Livermore FALCK AMBULANCE DEPLOYMENT -CHANGE ,.~ -' ~.~_ ,, ~ -, ~s ,-:. - ~ ;' ~ ~ ~~ ,., , ; ~~ ' m.,~ • As of July 1, 2019, there are three (3) Falck ambulance hub locations in Alameda County. The hubs are strategically placed in order to serve the geographic zones of the County. NORTH ZONE • Falck acquired a main operating location on Industrial Blvd. in Hayward. This location, pictured above, houses their administrative staff, fleet maintenance as well as serve as their main deployment hub to include the deployment of ambulances in the North Zone. In addition, in order to provide better coverage, Falck acquired a second North zone hub in the North Oakland area. The North Zone allocated two EMS Supervisors; one deploys from Hayward and the second deploys from the North Oakland hub. SOUTH ZONE • Due to the central location of their main hub in Hayward, Falck is utilizing the location as their main deployment hub. Maximizing the utilization of this location enables the rotation of ambulances through maintenance and out to the North Oakland and East Zone hubs. This serves as the central distribution center for supplies and equipment. The ambulances and the EMS Supervisor for the South Zone deploy from this location. EAST ZONE • Falck has procured a hub in the City of Livermore in order to serve the East zone. This facility has a classroom to facilitate meeting and training, as well as office space. The ambulances and the EMS Supervisor for the East Zone deploy from this location Page 9 EXECUTIVE SUMMARY —SECTION 2: SYSTEM OPERATIONS AND REGULATORY COMPLIANCE DISPATCH PRIORITIZATION CHANGE • Response Re-Prioritization =Sending the right resource, in the right amount of time based on current dispatch triage mechanisms and historical data. • The prioritization of calls shifted from an ALPHA through ECHO based system to a priority-based system. Priority 1, 2 or 3 calls will receive a Code 3 or lights and sirens response, as they are the higher acuity calls while Priority 4 calls, which are low acuity calls, will receive a Code 2 or no lights or sirens response. Priority 3 calls originate from medical facilities, which makes the need for fire resources call dependent. For Priority 4 calls, each fire department can determine their response based upon the expectation of their communities. Within the Priority 4 category, there are six (6) determinants that require an ALS ambulance response while the remainder may receive either ALS or BLS ambulances. The six (6) determinants requiring ALS ambulance response are: 01 C —Abdominal Pain, 17 B- Fall, 23C —Overdose/Poisoning, 26D —Sick Person, 30B — Traumatic Injury, and 32D- Unknown Problem (person down). INCREASED UTILIZATION OF BLS • Previously Paramedics Plus was authorized to utilize BLS ambulances to respond to 5150, Alpha-level, and Bravo-level calls, however Paramedics Plus opted to only utilize their limited BLS ambulances to respond to 5150, Alpha-level, and 4 specific Bravo-level calls. With the implementation of the priority-based system detailed above, a broader opportunity to utilize BLS ambulance for low acuity calls will be available to Falck. DISPATCH SERVICES • ACRECC, the Alameda County Regional Emergency Communications Center, managed by the Alameda County Fire District, is the dispatch center for Falck as well as multiple Fire agencies within the County. AMBULANCE ACQUISITION • Falck purchased 77 brand new ambulances which were delivered May 1, 2019. EQUIPMENT PROCUREMENT • Purchasing all new equipment while maintaining the same type of equipment used previously by providers in the field to mitigate the need for additional training or in-service. Efforts made to mirror Fire agency equipment configurations in order to promote greater interoperability and fluidity on scene of calls. TRANSITION TO ESO Electronic Health Record (HER) PLATFORM • Platform was ranked as the preferred platform by the Alameda County Fire Chiefs EMS Section Committee Increased ability to interface with hospitals for the exchange of patient care information. Page 10 EXECUTIVE SUMMARY SECTION 2 -SYSTEM OPERATIONS AND REGULATORY COMPLIANCE NEW CHANGES, UPDATES, 8 MODIFICATIONS EXPANDED PERFORMANCE ANALYSIS • FirstWatch will provide operational and clinical performance analysis of the EMS system identifying system successes and opportunities to improve services to Alameda County. EMS COMMITTEES -CURRENT AND NEW: LOCAL EOA PROVIDER AND TRANSITION MEETINGS COUNTYWIDE DISPATCH COMMITTEE (MDRC) —COORDINATION QUALITY COUNCIL MEETING ALAMEDA COUNTY REGIONAL EMERGENCY COMMUNICATIONS CENTER OPERATIONS MEETING ALAMEDA COUNTY FIRE CHIEF'S ASSOCIATION AND EMS SECTION NON-EMERGENCY PERMITTED AMBULANCE PROVIDER MEETINGS RECEIVING HOSPITALCOMMITTEE TRAUMA AUDIT COMMITTEE KAISER OAKLAND APOT WORKGROUP EMS COORDINATOR MEETINGS ALAMEDA COUNTY COMMUNICATIONS SECTION GROUP • PEDIATRIC READINESS, EMSC, AND SURGE COMMITTEE (EMSC ADVISORY COMMITTEE) STROKE COLLABORATIVE STEERING COMMITTEE AND RECEIVING CENTER MEETINGS • STEMI/ CARDIAC ARREST RECEIVING CENTER MEETINGS REGIONAL I S7ATE DISASTER MEDICAL CO-LOCATION OF CARE PROVIDERS MEETINGS UASI MEDICAL SHELTER COMMITTEE HPP COORDINATORS MEETING NICU TASK FORCE—JOINT ALAMEDA/CONTRA COSTA Co. EMERGENCY MANAGERS ASSOCIATION (EMA) MHOAC • UCSF BENIOFF CHILDREN'S HOSPITAL OAKLAND — • EMERGENCY PREPAREDNESS MEETINGS . CDPH/EMSA PEDIATRIC SURGE COMMITTEE • SENIOR INJURY PREVENTION CONFERENCE COMMITTEE CDPH/EMSA PEDIATRIC SURGE EMS SUB-COMMITTEE EMS WEEK PLANNING MEETINGS HPP CORRDINATORS MEETING —REGIONAL HCSA EMERGENCY OPERATIONS LEADERSHIP &PLANNING WORKGROUPS ABAHO SUB-COMMITTEE AND WORKGROUPS (REGIONAL MAC &MEDICAL SHELTER PROJECTS) HOSPITAL COMMAND CENTER 700/800 COMMUNICATIONS TESTING EMSA - EMSC TECHNICAL ADVISORY COMMITTEE DISASTER PREPAREDNESS HEALTH COALITION (DPHC) /STEERING COMMITTEE . REGIONAL TRAUMA COORDINATING COMMITTEE (RTCC) EMS GENERAL ADMINISTRATION -SYSTEM INFORMATION TECHNOLOGY UPGRADE • Alameda County EMS upgraded to the Microsoft Once 365 and conducted two department-wide trainings OPERATIONAL AREA EOC MEDICAL/ HEALTH BRANCH AND EMS BRANCH DOC - TECHNOLOGY UPGRADES -OPTIMIZE FUNCTIONALITY • ALCO EMS collaborated with the Sheriff's Department Office of Emergency Services and Homeland Security to upgrade the operational area EOC Medical/Health Branch with improved physical space functionality and technology assets. Planning to upgrade and relocate Medical/Health Branch to a larger room has been completed including. furniture and equipment upgrades. The EMS communications system at the Branch has been upgraded with new radio communications technology. • Similar to the EOC, the EMS Branch DOC has been enhanced with automated information technology control systems and hardware in a single room. The implementation of a turn-key audio-visual communications system has provided EMS staff with more effective and efficient means of accessing and tracking information including ReddiNet and incoming SitStat requests, and thereby managing local emergencies Page 11 EXECUTIVE SUMMARY SECTION 2 -SYSTEM OPERATIONS AND REGULATORY COMPLIANCE MOBILE OFF-SITE OPERATIONAL CAPABILITY • EMS Director, EMS Deputy Director and EMS Coordinators have mobile laptops with extended life batteries and enhanced connectivity to ensure operational self-sufficiency, reliable communications and information management capability. Satellite-based voice and data communications technology procured and implemented. Each EMS Duty Officer provided with multi-band capable portable emergency communications radio. FIRE DEPARTMENT TRANSITIONS -ORGANIZATIONAL LEADERSHIP Numerous changes have occurred in the Fire Department leadership. Fire Chiefs in several jurisdictions have changed including Piedmont and Livermore/Pleasanton. SYSTEM OPERATIONS AND CONTRACT COMPLIANCE COMPLIANCE MANAGEMENT FOR CONTRACTS • Ongoing compliance management for contracted EMS providers, including Falck, Paramedics Plus (previous provider), Fire Department providers, and Emergency Medical Dispatch providers (Alameda County Regional Emergency Communications Center and Oakland Fire Department). Expanding the use of FirstWatch Online Compliance Utility (OCU) to monitor compliance and overall performance by all contracted and permitted EMS providers. CONTRACT EXTENSIONS - FRALS AND FIRE TRANSPORT- CHANGES, UPDATES, &MODIFICATIONS • As previously noted, Paramedics Plus's contract was extended through June 30, 2019 and ended on this date. ALCO EMS has implemented successor 911 ambulance agreements with Falck and the cities of Alameda, Albany, Berkeley and Piedmont. n Extensions of the Alameda County Regional Emergency Communications Center (ACRECC) emergency medical dispatch, First Responder Advanced Life Support (FRALS) as well as 4 fire department-based 911 ambulance transport agreements were negotiated and executed. Refer to table below: CONTRACTOR TYPE END DATE Alameda County Fire Dept. FRALS 6/30/2024 Alameda County Fire Dept. ACRECC Medical Dispatch Services Agreement 6/30/2024 City of Alameda Separate FRALS and Ambulance Transport Agreements 6/30/2024 (Both) City of Albany Separate FRALS and Ambulance Transport Agreements 6/30/2024 (Both) City of Berkeley Separate FRALS and Ambulance Transport Agreements 6/30/2024 (Both) City of Dublin FRALS 6/30/2024 City of Emeryville FRALS 6/30/2024 City of Fremont FRALS 6/30/2024 City of Hayward FRALS 6!30/2024 City of Livermore FRALS 6/30/2024 City of Newark FRALS 6/30/2024 City of Oakland FRALS 6/30/2024 City of Piedmont Separate FRALS and Ambulance Transport Agreements 6/30/2024 (Both) City of Pleasanton FRALS 6/30/2024 City of San Leandro FRALS 6/30/2024 City of Union City FRALS 6/30/2024 Page 12 EXECUTIVE SUMMARY SECTION 2 —SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, 8 MODIFICATIONS PROCUREMENT /CONTRACT SUMMARY FY 2018-2019 —EMS PROCUREMENTS AND CONTRACTS -SUMMARY EMS MASTER LIST OF MOOS PROGRAM LEAD TYPE Alta Bates Summit Medical Center Campus Mike Jacobs Stroke and STEMI /Cardiac Arrest MOU UCSF Benioff Children's Hospital, Oakland Trauma Contract Kaiser Permanente Oakland Stroke and STEMI/Cardiac Arrest MOU Alameda Health Systems, Highland STEMI Cardiac Arrest MOU and Trauma Contract Alameda Health Systems, Alameda City Hospital Stroke MOU Kaiser Permanente San Leandro Stroke MOU Kaiser Permanente Fremont Stoke and STEMI/Cardiac Arrest MOU St. Rose Hospital STEMI Cardiac Arrest MOU Washington Hospital, Fremont Stroke and STEMI /Cardiac Arrest MOU Stanford Valley Care, Pleasanton STEMI MOU /Cardiac Arrest MOU Eden Castro Valley Stroke MOU and Trauma Contract UCSF Benioff Children's Hospital, Oakland Cynthia Frankel EMSC and Pediatric Readiness Project PROGRAM PARTNERS/PROVIDERS PROGRAM PARTNERS/PROVIDERS Trauma Alameda Health System, Adult Trauma EMS Definitive Networks, Incorporated Trauma Alameda Health System, Adult Trauma Dispro EMS Beyond Lucid Technologies Trauma Alameda Health System, Base Hospital EMS Office of Administrative Hearings (DGS) Trauma Sutter Health Eden Med Center, Trauma EMS UCSF Fellowship Trauma Sutter Health Eden Med Center, Trauma Dispro EMS Hospital Association of Southern CA (HASC) ReddiNet Trauma UCSF Benioff Children's Hospital Pediatric Trauma EMS UCSF Benioff Children's Hospital, Pediatric Readiness and Hospital PedRC Agreements Trauma UCSF Benioff Children's Hospital Pediatric Trauma Dispro EMS Physio-control/Pulse-point FRALS ACRECC Ambulance Dispatch Services EMS City of Alameda, Community Paramedicine FRALS Alameda County Fire Department, FRALS EMS AHS MOU Community Paramedicine FRALS City of Alameda, Separate FRALS and Ambulance Transport Agreements EMS Base Hospital Contract FRALS City of Albany, Separate FRALS and Ambulance Transport Agreements EMS Target Solutions FRALS City of Berkeley, Separate FRALS and Ambulance Transport Agreements EMS RDMHS State FRALS City of Dublin, FRALS EMS Zoll Data Systems FRALS City of Emeryville, FRALS EMS FirstWatch FRALS City of Fremont, FRALS EMS ESO Solutions, Inc. FRALS City of Hayward, FRALS Pipeline Youth Alive FRALS City of Livermore, FRALS SIPP City of Fremont, Afghan Health & Med Safety FRALS City of Newark, FRALS SIPP Daybreak Adult Care Centers FRALS City of Oakland, FRALS SIPP Senior Support Program of Tri Valley FRALS City of Piedmont, Separate FRALS and Ambulance Transport Agreements SIPP St. Mary's Center, Medication Safety Pilot FRALS City of Pleasanton, FRALS SIPP United Seniors of Oakland &Alameda County FRALS City of San Leandro, FRALS FRALS City of Union City, FRALS Page 13 EXECUTIVE SUMMARY SECTION 2 —SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, &MODIFICATIONS NON-EMERGENCY PERMITTED PROVIDERS —CONTRACTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- ENSURE SYSTEM OVERSIGHT, COORDINATION AND SURGE CAPACITY ALCO EMS NON-EMERGENCY PERMITTED AMBULANCE PROVIDERS Ambulance roviders ermitted for non-emer enc o erations in Alameda Count are listed in table below: PROVIDER TYPE OF CONTRACT DATE CONTRACT SIGNED START DATE DATE EXPIRES EAGLE N/A —Permitted through County Ambulance Ordinance BUTTER —AMR N/A —Permitted through County Ambulance Ordinance • AMR West Critical Care Paramedic (CCP) 5125/2018 6/112018 5123112023 ROYAL AMBULANCE N/A —Permitted through County Ambulance Ordinance NORCAL AMBULANCE NJA—Permitted through County Ambulance Ordinance UNITED AMBULANCE N/A —Permitted through County Ambulance Ordinance FALCK AMBULANCE BLS N/A —Permitted through County Ambulance Ordinance FALCON CCT N/A —Permitted through County Ambulance Ordinance PROTRANSPORT-1 N/A —Permitted through County Ambulance Ordinance ARCADIA AMBULANCE N/A —Permitted through County Ambulance Ordinance BAYSHORE AMBULANCE CLOSED 4/28/2019 BAYMEDIC AMBULANCE N/A —Permitted through County Ambulance Ordinance WESTMED AMBULANCE N/A —Permitted through County Ambulance Ordinance SACRAMENTO VALLEY AMBULANCE N/A —Permitted through County Ambulance Ordinance PERMITTED NON EMERGENCY AMBULANCE PROVIDER (BLS Providers) - CWANGES • Eagle Ambulance and Sacramento Valley Ambulance added as Alameda County permitted provider under Alameda County Ambulance Ordinance. • Bayshore Ambulance closed effective 4/28/2019. NON-EMERGENCY PERMITTED AMBULANCE PROVIDERS —DISASTER READINESS • Continued integration of BLS Providers into the County disaster plan to assist in large-scale treatment and transport of patients. Supported the deployment of BLS Providers to the Butte Camp Fires 2018, and provided assistance to all participants in acquiring County and State reimbursement for services rendered. • These providers trained their EMTs on the new expanded State scope of practice and the associated equipment required as part of their ambulance inventory effective January 1, 2019. (epinephrine, naloxone, pulse oximetry, and glucose sampling and measurement). • Continued development and support of emergency communication radio infrastructure of BLS Providers, ensuring compatibility with 911 public safety and receiving hospital radio communications systems. Established new radio Code Plug for BLS Providers facilitating County/State EMS radio interoperability and continued to monitor radio use compliance. NEXT PAGE Page 14 EXECUTIVE SUMMARY SECTION 2 -SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, 8~ MODIFICATIONS CRITICAL CARE PARAMEDIC (CCP) • EMSA allows Critical Care Paramedic (CCP) interfacility transport of patients and requires that Alameda County EMS monitor and regulate all paramedic prehospital care. EMS has adopted the use of state and national inter- facilitytransport standards to monitor and regulate this program. The CCP Interfacility Transport Agreement with American Medical Response West incorporates County EMS guidelines and standards, patient transfer protocols, data collection and reporting requirements that ensure patient safety. Alteplase (TPA) and Norepinephrine were added to the local optional scope of practice for CCP. COMMUNICATION SYSTEM OPERATIONS COMMUNICATIONS ePCR/EHR -DEFINITIVE NETWORKS INCORPORATED HOSTING /Training Services • Refer to 2017-18 Progress Update form for additional information. Definitive Networks Incorporated Data Hosting /Training Services contract extended to October 2019. REDDINET -UPGRADES AND TRAINING • ReddiNet new contract effective June 1, 2019 which provides access for EMS, ACRECC, Falck, ALS FRALS Transport providers, 9-1-1 ambulance receiving facilities, non-hospital healthcare facilities, and 5150 receiving sites. ReddiNet training and exercise conducted on-site for Public Health, hospitals, City of Oakland OES, and other ReddiNet users as needed. Cynthia Frankel, ReddiNet Coordinator will continue to support ReddiNet training needs. • ReddiNet redesign rolled-out in September 2018. Focused training on ReddiNet medical surge and patient tracking with functional exercises. CERTIFICATIONS AND INVESTIGATION EMT CERTIFICATIONS • Ongoing management of EMT certifications granted through Alameda County EMS, and investigation of all alleged misconduct relative to the standards of professional licensure. • Ongoing support of several regulatory investigations associated with EMS Training Program operations within the County. NEXT PAGE Page 15 EXECUTIVE SUMMARY SECTION 2 -SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, 8 MODIFICATIONS EMS ADMINISTRATION POLICIES and FIELD PROTOCOLS 2020 FIELD MANUAL PROTOCOL PENDING UPDATES 2020 FIELD MANUAL DEVELOPMENT - TO BE IMPLEMENTED BY JANUARY 1, 2020 (Planning started April 2019; Pending approvals) ADMINISTRATIVE • Added new staff to Staff Directory (p. VI) • Updated Abbreviations (p. VIII) GENERAt~. SECTION • ASSAULTIABUSElDV (p. 5) o Added if a rescuer knows or reasonably suspects a person suffering from any wound or other physical injury inflicted upon the person where the injury is the result of assaultive or abusive conduct, notify Law Enforcement pursuant to AB 1973. BURN PATIENT CARE (p. 7) o Modified pre-hospital fluid formula to align with ATLS guidelines. (Pt Weight in Kg x TBSA %)/8 =Rate (mUhr) • TXA (p. 28) o Modified to "suspected" cervical cord injury and added "Other massive uncontrolled hemorrhage (e.g. GI bleeding, dialysis shunt bleeding, vaginal bleeding, post-partum hemorrhage, etc.)" to inclusion criteria. ADULT I PEDIATRIC SECTIONS • ACUTE STROKE (Adult p. 30) o Modified Time of Onset "must be within 24 hours, observed by a reliable witness or reported by a reliable patient (for thrombolysis)". • PAIN MANAGEMENT (Adult p. 41, Pediatric p. 66) o Added Ketorolac (Toradol) for Adults age 15 — 65 y. o. o Added Pain Management Algorithm to Adult and Pediatric Protocols • RESPIRATORY DEPRESSION (Adult p.44, Pediatric p. 72) o Modified algorithm and format, no substantive changes • SEIZURE (Adult p. 49, Pediatric p. 76) o Modified Adult IM/IN dose to 10 mg o Modified Adult preferred route to IM o Modified Pediatric IM dose to 0.2 mg/kg o Maintained Pediatric preferred route of IN (0.2 mg/kg) • PEDIATRIC —Airway Obstruction (p. 62), Neonatal Resuscitation (p. 67), Poisoning (p. 71), Respiratory Depression (p. 74), Respiratory Distress (p. 75-76), Routine Medical Care (p. 77) o Added iGel utilization for pediatric patients < 40 kg if BVM ventilation is inadequate • MEDICATIONS (Adult p. 41) o Added Ketorolac 15 mg IM/IV/10 o Modified Midazolam initial dose to 10 mg IM/IN in Adults NEXT PAGE Page 16 EXECUTIVE SUMMARY SECTION 2 —SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, 8 MODIFICATIONS EMS ADMINISTRATION POLICIES and FIELD PROTOCOLS 2020 FIELD MANUAL DEVELOPMENT - TO BE IMPLEMENTED BY JANUARY 1, 2020 OPERATIONS SECTION EQUIPMENT (p. 98 - 104) o Modified various minimum equipment and supply inventory requirements on ALS and BLS response vehicles o Removed 14g IV Catheter o Added 22g x 1.5" IM Needle o Added i-gel o Added Ketorolac • OLANZAPINE (p. 134) o Removed from CONTRAINDICATIONS - "Agitation requiring restraints" o Added to INDICATIONS - "IAW Restraint Policy (P.111), restraints may be utilized after patient self-administers Olanzapine." PROCEDURES SECTION • ADVANCED AIRWAY (p. 116) o Added i-gel Supraglottic Airway as a backup advanced airway adjunct for adult and pediatric patients • HEMORRHAGE CONTROL (p. 126) o Modified Any standard gauze or County-approved hemostatic gauze may be utilized PLEURAL DECOMPRESSION (p. 132) o Removed mid-axillary line (MAL) site, 2nd ICS-MCL remains • SEDATION (Adult) (p. 137) o Modified Midazolam to Total Maximum Dose of 10mg MCI SECTION • MCI (p. 159) o Added Defined MCI Resource Response Packages o Added "Note: Immediately cancel assigned resources) when no longer required" o Added Defined MCI Notifications NEXT PAGE Page 17 EXECUTIVE SUMMARY SECTION 2 —SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, S MODIFICATIONS 2019 FIELD MANUAL PROTOCOL UPDATES ADMINISTRATIVE • AMBULANCE REROUTING CRITERIA —Hospital Bypass Removed GENERAL SECTION • HYPERKALEMIA o MODIFY Albuterol Dose to 10-20 mg o MODIFY Signs/Symptoms (weakness, N/V, CP, palpitations, SOB, numbness etc.) o ADD n ECG Change Progression associated with Hyperkalemia progression n NaHCO3 Contraindication/Caution • Albuterol Contraindication/Caution • LOCAL OPTIONAL SCOPE OF PRACTICE o Pediatric Intubation removed per EMSA requirement o Olanzapine added o TXA added o EMT added procedures and medication (ASA, Epinephrine (Anaphylaxis), Glucometry, Pulse Oximetry, Naloxone) • TXA — p. 28 -California Prehospital Antifibrinolytic Therapy (Cal-PAT) Study — o "Improved mortality;" "The mortality difference was greatest in severely injured patients." o "Significant reduction in total blood transfusion" ADULT /PEDIATRIC SECTIONS • ANAPHYLAXIS ADULT -Clarifies BLS administration of Epinephrine in Anaphylaxis • ANAPHYLAXIS PEDIATRIC Clarifies BLS administration of Epinephrine in Anaphylaxis • ASYSTOLE/PEA ADULT Administer Epi, (after IVl10), Q10 mins, up to 3 doses • ASYSTOLE/PEA PEDIATRIC Pediatric Intubation (< 40 kg) removed per EMSA requirement, Administer Epinephrine, (after IV/10), Q10 mins, up to 3 doses • VF/VT ADULT Administer Epinephrine, (after IV/10), Q10 mins, up to 3 doses • VF/VT PEDIATRIC Pediatric Intubation (< 40 kg) removed per EMSA requirement, Administer Epinephrine, (after IV/10), Q10 mins, up to 3 doses • AIRWAY OBSTRUCTION Pediatric Intubation (< 40 kg) removed per EMSA requirement • NEONATAL RESUSCITATION Pediatric Intubation (< 40 kg) removed per EMSA requirement • POISONING Pediatric Intubation (< 40 kg) removed per EMSA requirement • RESPIRATORY DISTRESS Pediatric intubation (< 40 kg) removed per EMSA requirement • ROUTINE MEDICAL CARE Pediatric Intubation (< 40 kg) removed per EMSA requirement OPERATIONS SECTION e BLS/ALS FIRST RESPONDER p. 87 o Clarifies First Responder Personnel Page 18 EXECUTIVE SUMMARY SECTION 2 —SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, 8 MODIFICATIONS 2019 FIELD MANUAL PROTOCOL UPDATES • DEATH IN THE FIELD p. 88 -MODIFY Medical (Cardiac) Arrest -Discontinuation of CPR: if non-shockable rhythm persists, despite appropriate, aggressive ALS interventions for 30 minutes (OR if ETCO2 < 10 after 20 minutes), consider discontinuation of CPR • EQUIPMENT p. 98-104 -Clarifies equipment specifications associated with 2019 field policy updates • IFT MODIFY Base Contact Requirements 5.3 from "closest" to "closest most appropriate" • OLANZAPINE (ADD -NEW) —Move to Procedures Section • PSYCHIATRIC AND BEHAVIORAL EMERGENCIES o Excited Delirium algorithm pathway converges links to applicable existing field manual treatment policies. • RESPONDING UNITS —_Modified Canceling/Reducing Code • UNUSUAL OCCURRENCE -Identifies improvement opportunities in clinical outcomes and/or system structures / processes. PROCEDURES SECTION • ADVANCED AIRWAY o Pediatric Intubation removed per EMSA requirement • CONSENT AND REFUSAL GUIDELINES o "Competent....." modified to "Patient, parent, or guardian must have legal and mental Decision Making Capacity." "The Assess and Refer process identifies patients whose condition does not require transport by 911 emergency ambulance. Ail 911 calls for EMS will receive an appropriate response, timely assessment and appropriate patient care." • ASSESS AND REFER (NEW FIELD POLICY) o An alternative for select 911 patients who have been evaluated by a Paramedic. o Work group established and a survey of Alameda County Paramedics about acceptability and issues with policy was completed and collated. o Pilot program currently in progress o Further work planned on operational and training aspects of this policy with full implementation anticipated January 2019. o Does the patient, parent, or guardian have Decision Making Capacity? o How concerned are you with this patients current medical issue? o How likely is this patient to successfully navigate the provided referral? • HEMORRHAGE CONTROL -September 2015 American College of Surgeons Bulletin o Wound Packing added "After significant feedback from experienced military medics, in 2003 the CoTCCC recommended a hemostatic dressing that could be packed into a wound but that had hemostatic performance that was superior to standard gauze." Page 19 EXECUTIVE SUMMARY SECTION 2 -SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, &MODIFICATIONS 2018 EMS ADMINISTRATION POLICIES and FIELD MANUAL PROTOCOLS 2018 FIELD MANUAL PROTOCOL UPDATES - (DEVELOPED IN 2017, IMPLEMENTED JANUARY 2018) GENERAL SECTION • ASSAULT/ABUSE/DOMESTIC VIOLENCE — If patient not transported and if safe, appropriate and feasible, perform a DV Lethality Screen, Added DV algorithm • BURN PATIENT CARE —Remove Base contact requirement • CPR — Update CPR Matrix to 2015 AHA guidelines, Remove hypoglycemia as cause of persistent arrest Added Mechanical CPR Contraindications e CRUSH SYNDROME —Removed Base Contact Requirement • HYPERKALEMIA —Added Albuterol • LOCAL OPTIONAL SCOPE —Added Pulse Oximetry, Glucometer, ASA, Epinephrine AdulUPediatric Auto Injectors, Naloxone training and supplies required for BLS 911 • TRANSPORT GUIDLELINES - "reasonable transport time" should be considered for transport destination ADULT /PEDIATRIC SECTIONS • RESPIRATORY DEPRESSION —Simplified treatment algorithm • BRADYCARDIA/ROSC/SEPSIS/SHOCK POLICIES —Added Push Dose Epinephrine. Remove Dopamine • NEONATE —Added "In healthy full-term newborns, routine bulb syringe suctioning is not indicated" • ACUTE STROKE -Facilitates communication of stroke witness information for 2018 with addition of assessment gaze • ASYSTOLE /PEA -Aligns with AHA ACLS guidelines • SHOCK Added push dose Epinephrine • EPINEPHRINE —Simplified epinephrine concentration and use of push dose Epinephrine for shock • SEPSIS Modified fluid administration, added push dose Epinephrine • ALTE Modified to BRUE PROCEDURES SECTION • ALS RESPONDER - "First Responder and transport personnel providing patient care are responsible for accurately documenting all available and relevant patient information on the electronic health record." DEATH IN THE FIELD —UPDATED POLICY —Clarified patient treatment and withholding resuscitation • ADVANCED AIRWAY MANAGEMENT — ETT "Attempt 'definition is "insertion of laryngoscope blade" • DEATH IN THE FIELD —Clarified patient treatment and withholding resuscitation • INTRAOSSEOUS INFUSION —Added Humeral 10 route MCI • MCI POLICY —Clarified patient triage, transport, and tracking; SALT or START triage can be used for pediatric patients. Page 20 EXECUTIVE SUMMARY SECTION 2 —SYSTEM OPERATIONS AND REGULATORY COMPLIANCE CHANGES, UPDATES, 8 MODIFICATIONS 2018-2019 ADMINISTRATION POLICIES • TRAUMA RE-TRIAGE PROCEDURE iADULT) —MODIFIED JANUARY 2018 • TRAUMA RE-TRIAGE PEDIATRIC (PEDIATRIC) —MODIFIED JANUARY 2018 • PUBLIC SAFETY NALOXONE o Law Enforcement Programs to provide naloxone (Narcan) for suspected opiate overdoses o Refer to the table below for approved "Naloxone" programs and programs with inquiries but no approval. LAW ENFORCEMENT PROGRAMS STATUS DATE APPROVED ALAMEDA COUNTY SHERIFF'S OFFICE APPROVED 7/24/2018 • BART POLICE DEPARTMENT INQUIRIES ONLY NO APPROVED PROGRAM • BERKELEY POLICE DEPARTMENT APPROVED 8/2 012 0 1 8 • EAST BAY PARKS POLICE DEPARTMENT APPROVED 2/13/2018 • FREMONT POLICE DEPARTMENT APPROVED 10/6/2017 • HAYWARD POLICE DEPARTMENT APPROVED 6/27/2018 • LIVERMORE POLICE DEPARTMENT APPROVED 7/24/2018 • NEWARK POLICE DEPARTMENT APPROVED 11/17/2017 • QAKLAND HOUSING AUTHORITY APPROVED 10/10J2018 • OAKLAND POLICE DEPARTMENT APPROVED 7/2/2018 • PLEASANTON POLICE DEPARTMENT APPROVED 11/2018 • SAN LEANDRO POLICE DEPARTMENT APPROVED 7/23/2018 • UC BERKELEY POLICE DEPARTMENT APPROVED 10/10/2018 • UNION CITY POLICE DEPARTMENT APPROVED 6/6/2018 NEXT PAGE Page 21 EXECUTIVE SUMMARY -SECTION 3: CLINICAL SYSTEMS OF CARE CHANGES, UPDATES, 8 MODIFICATIONS CLINICAL SYSTEMS OF CARE AND SPECIALTY CENTERS —RESULTS BASED ACCOUNTABILITY Consistent with the state regulations and Alameda County Health Care Services Agency mission, ALCO EMS prioritizes promoting health equity and results based accountability in ALCO EMS programs. Refer to examples: SPECIALTY_CENTERS STROKE RECEIVING CENTERS Alameda County EMS ensures that patients who are experiencing a possible cerebral vascular accident (Stroke) on scene, detected by clinical assessment, are transported to an EMS designated hospital (MOU in place) for specialty diagnostics and treatment: CT/CTA and if needed, IV fibrinolytic and or transfer to a comprehensive capable center for IR services. STEMI/CARDIAC ARREST RECEIVING CENTERS • Alameda County EMS ensures that patients who are experiencing a possible ST-elevation myocardial infarction (STEMI) on scene, detected by clinical exam and 12-lead electrocardiogram, are transported to an EMS designated hospital (MOU in place) for specialty diagnostics and treatment: coronary angiogram and if needed a Primary Percutaneous Coronary Intervention (PCI). Alameda County EMS also ensures that patients who were pulseless on scene or during transport who received attempted resuscitation and experience return of spontaneous circulation (ROSC) or presented with VFNT are also transported to EMS designated STEMI / Cardiac Arrest Receiving Center hospitals (MOU in place), as these patients frequently require some of the same interventions. In addition to PCI, these specialty receiving facilities provide appropriate use of Targeted Temperature Management, Metabolic and Circulatory support as well as other diagnostic tests and therapies that are specific to post cardiac arrest patients. TRAUMA RECEIVING CENTERS • The Alameda County EMS Agency ensures overall trauma system design, monitoring and quality improvement, including trauma center designation and administration of the associated contracts. The Trauma quality benchmarks include: 1} Maintenance of a trauma registry to track trauma system and trauma center perFormance on a case-by-case basis using the Lancet Trauma 1 database; 2) A bi-county Trauma Audit Committee (TAC), the purpose of which is to facilitate the quality assurance and improvement process by including outside experts for performance review of both the trauma centers and system on a quarterly basis; 3) Full participation in CEMSIS Trauma and EMS data sharing with the intent to improve patient outcomes; 4) Representation/participation at the State designated Regional Trauma Coordinating Committee (RTCC); 5) Representation/participation at internal Trauma Center Process Improvement and Clinical Oversite meetings. PEDIATRIC RECEIVING CENTERS • The Alameda County EMS Agency ensures overall EMS for Children (EMSC) system integration, design, monitoring and quality improvement. Alameda County EMS has a contract with the pediatric trauma center University of California San Francisco Benioff Children's Hospital, Oakland (Level 1 Trauma Center) to ensure hospital quality improvement for hospital pediatric day-to-day readiness, injury prevention, and disaster/surge capability. All hospitals are expected to receive pediatric patients with pediatric readiness. The hospital benchmarks recommend employment of a pediatric coordinator and quality improvement (QI) activities, policies and age-based equipment, as well as injury prevention and disaster preparedness programing. Page 22 EXECUTIVE SUMMARY -SECTION 3: CLINICAL SYSTEMS OF CARE CLINICAL SYSTEMS OF CARE -HOSPITALS -NEW CONTRACTS ALAMEDA COUNTY BASE HOSPITAL • Gene Hern, MD is the new Base Hospital Medical Director as of August 2019. TRAUMA CENTERS -Master Contract Amendments • Trauma Center Agreements negotiated and implemented for services through 2021 with: o Alameda Health System —Highland Hospital o UCSF Benioff Children's Hospital Oakland o Sutter Health -Eden Hospital • Verification by the American College of Surgeons' Committee on Trauma continues as a requirement of the Alameda County Trauma Center agreements. CARDIAC ARREST, STROKE, AND STEMI STEMI/CARDIAC ARREST, STROKE RECEIVING CENTER - Agreement RENEWALS: • Negotiated and implemented three year Agreements for Washington Hospital (STEMI/Cardiac Arrest and Stroke Receiving Center), Kaiser Fremont (STEMI/Cardiac Arrest Receiving Center), Highland (STEMI/Cardiac Arrest Receiving Center), Summit Medical Center (Stroke Receiving Center). STEMI/CARDIAC ARREST RECEIVING CENTER —NEW MOU: New STEMI receiving hospital Kaiser Permanente Oakland. Established new Agreement for Kaiser Permanente Oakland (STEMI/Cardiac Arrest Receiving Center) with service initiated January 1, 2017. STROKE RECEIVING CENTER —NEW DESIGNATION: • New Stroke Receiving Center designation for Stanford ValleyCare. MOU in development with service initiated on September 4, 2019 after JCAHO certification. HOSPITAL PEDIATRIC READINESS PROJECT -STRENGTHEN PEDIATRIC READINESS • Contract with UCSF Benioff Children's Hospital provides for Emergency Department (ED) Pediatric Readiness Project Site Visits and follow-up reports with recommendations reviewed with participating hospitals for improvement. The associated on-going review processes for participating hospitals were scheduled from January 2017 through January 2018. Negotiated and submitted new Agreement to County Board of Supervisors for UCSF Benioff Children's Hospital provided Pediatric Readiness Project services in August 2018. New contract January 1, 2019 to December 31, 2019. Alameda County EMS has scheduled all pediatric site visits for 2019 and 2020. Implementing EMSA EMSC regulations. HOSPITAL MERGERS • Although significant Alameda County hospital reorganizations occurred between 2015 and 2017, the EMS provider community continues to acclimate to these changes. Alameda County EMS continues to designate 13 receiving hospitals. Hospital systems operating within the County continue to reorganize through building expansions, structural improvements, mergers, and leadership changes. • Hospital landscape transitions that occurred in 2015, continue to have personnel organization changes in 2019: o Stanford Health Care — ValleyCare Hospital. -Emergency Management Position Changes o UCSF Benioff Children's Hospital in Oakland —Integrations occurring with UCSF Benioff Mission Bay, SF o Regional Kaiser Permanente Oakland -Emergency Management Position Changes o Kaiser Permanente San Leandro - ED and Emergency Management Position Changes o Kaiser Oakland Hospital -expanded with consolidated pediatric services in Oakland including the addition of pediatric beds in the pediatric intensive care unit. o Alameda Health System -expanded ED leadership for Alameda and San Leandro Hospitals. Page 23 EXECUTIVE SUMMARY -SECTION 3: CLINICAL SYSTEMS OF CARE PROGRAM ACCOMPLISHMENTS -SPECIALTY PROGRAM HIGHLIGHTS INNOVATION, MANAGEMENT, AND OPERATIONS -COMMUNITY PROJECTS, AND COALITIONS Alameda County Emergency Medical Services has been and continues to be on the forefront of EMS innovation, management, and operations. Refer to the examples below. EMS CORPS • EMS Corps is a full-time Alameda County EMS program designed to change the trajectory of Boys and Men of Color (BMOC) and create career opportunities for participants in EMS, public safety, and/or health care services. ALCO EMS facilitates the instruction of the EMT training component of the EMS Corps program, realistically preparing graduates for future success in the work environment. Cohort 14 ended on January 3, 2019 with a 100% final passage rate. 14 students passed the NREMT. One alumna is employed at Royal Ambulance. Cohort 15 classes started on February 8, 2019. HEARTSAFE PROJECT The HeartSAFE Project goal was envisioned to provide 185 Automated External Defibrillators (AEDs) with training, oversight, and maintenance in high risk/high traffic locations to increase Sudden Cardiac Arrest (SCA) survival rates in Alameda County. Alameda County EMS ensures this project remains sustainable and campaigns to promote community AEDs with the message: "When AED's are available and used within 3 minutes, the survival of someone suffering from Sudden Cardiac Arrest (SCA) outside of a hospital will increase from 5% to a survival rate of up to 70°/a. Ensuring timely access to an AED, will strengthen the links in the chain of survival in the County. Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates focus on timely and effective delivery of interventions by bystanders and EMS personnel." Alameda County EMS is continuing the HeartSAFE project without interruption with eighty three community Board of Supervisor sites for three years. The project includes maintenance of AEDs at each community location by Alameda County EMS. Maintenance of AEDs located at County-owned and leased sites will continue through collboration with Alameda County Risk Management for three years including AED/CPR training. CPR 7 and NEW CPR 9 • CPR 7 is a program developed for public school 7th graders in Alameda County. In the 6~h and 7th year (2015- 2017 school years), 17 middle schools in Alameda County participated. Approximately14,000 7'h graders were trained in cardiopulmonary resuscitation (CPR) and in turn trained their families and friends, multiplying (x4) the impact of their own participation in the program. The CPR 7 program was featured in a past edition of the Journal of Emergency Medical Services. As recently passed state legislation requires ninth graders that take health science be trained in Hands Only CPR as a graduation requirement, Alameda County EMS has transitioned towards supporting CPR 9 in a multi-year process. In 2017-19, Alameda County EMS implemented a pilot project providing reusable manikins instead of individual/disposable CPR training kits. EMS continues to support the new 9th grade CPR training effort using the reusable manikins. Page 24 EXECUTIVE SUMMARY SECTION 4 — 2018-19 WORKPLAN -NEW IDENTIFIED MAJOR NEEDS: 1. Falck Transition Phan for new contracted 911 emergency ambulance services to County Exclusive Operating Area (EOA) has been identified as the priority need; implement and monitor new contract for services to County's EOA. 2. Implement dispatch Priority based system. Optimally deploy prehospital personnel. Ensure BLS and ALS resource types to their full potential — "Ensure right resources are getting to the right patients in the right amount time." 3. Continue to facilitate reductions system-wide in Ambulance Patient Offload Time (APOT), Ambulance Patient Offload Delays (APOD) and the number of avoidable ambulance transports 4. Continue to monitor and ensure contract compliance - Falck, fire-based first responder and transport providers, and Alameda County Regional Communications Center as priorities. 5. Continue to develop /seek to participate in county-wide health data exchange with focus on bi-directional data exchange with all receiving hospitals. 6. Continue to finalize the Alameda County MHOAC Manual and Incident Response Guides for the Health Care Services Agency 7. Ensure compliance with the new EMS for Children Regulations. Continue to conduct pediatric readiness site visits and designate pediatric receiving centers. 8. Strengthen Medical Surge Plans for hospital bed expansion with focus on pediatrics, patient tracking, patient movement, and mass casualty events. • Facilitate CDPH/EMSA Pediatric Surge recommendations. Promote utilization of TRAIN Model for all Alameda County hospitals. • Continue to test ReddiNet customized polling to assess medical surge bed expansion capability • Continue to conduct the "No Notice /Limited Notice" Coalition Surge test for "real time" capability to identify evacuating patients and types of transport available for receiving hospitals. • Leverage cross sector partners to participate in medical surge/MCI preparedness and exercises including: health care facilities (hospitals, clinics, and skilled nursing facilities); 911 and non-911 ambulance providers; local jurisdictions (i.e. City of Oakland); and Alameda County Departments and Agencies including the Alameda County Office of Emergency Services, Health Care Services Agency (EMS, Public Health, Behavioral Health, and Environmental Health) • Further prepare for Ambulance Strike Team deployments, develop program and conduct continued training • Support Regional and State projects —Community Paramedicine, Ebola and Infectious Disease patient; California Patient Movement Plan, California CDPH /EMSA Pediatric Surge project, and pending proposed EMS for Children Regulations. • Ensure adequate supplies and ability to deploy them, including MCI Deployment Modules. • Continue to test Co-Location mass patient care concept with goal of broader program implementation. 9. Strengthen redundant and interoperable communication systems and provide customized training for ReddiNet, AC Alert, EBRCSA, and CAHAN. Page 25 EXECUTIVE SUMMARY SECTION 4— 2018-19 WORKPLAN NEW 10. Continue use of ReddiNet for Multi-Casualty Incident (MCI), disaster and receiving facility management while expanding the platform to provide behavioral health facility monitoring for the Community Assessment and Transport Team (GATT). 11. Ensure operational personnel deployable readiness for mutual support needs to operational areas outside of Alameda County 12. Facilitate ongoing Quality Improvement in conjunction with Specialty Receiving Centers -Continued data collection and process improvement for cardiac, stroke, trauma centers, and pediatric receiving centers. • Continue collection of system data to monitor system operational and clinical performance. • Monitor the migration of the patient care record from Zoll to the ESO platform. 13. Enhance Electronic Patient Care Reporting (ePCR) system with support for users including quality improvement data extracts and analysis and transition to electronic transfer of information to receiving hospitals. 14. Conduct Pediatric Readiness "day-to-day" and Medical Surge Hospital Emergency Department Site Visits. Implement new agreement with UCSF Benioff Children's Hospital Oakland to strengthen pediatric readiness project for hospital and prehospital partners. 15. Promote retention and further development of existing specialty care centers including trauma centers: UCSF Benioff Children's, Highland (Alameda Health System), and Eden Hospitals. Maintain ACS Verification as a requirement of the contracts with trauma centers and completion of a System-Wide Trauma Evaluation by the ACS. 16. Develop and implement alternative resources for care and transportation of behavioral health clients on 5150 Welfare and Institutions Code holds. 17. Continue work on Stop the Bleed campaign, Phase II. NEXT PAGE Page 26 EXECUTIVE SUMMARY SECTION 4- 2018-19 WORKPLAN NEW GOALS: 1. Support and monitor the Falck transition. Implement new contract for services to County's EOA. 2. Initiate planning for future RFP for 911 emergency ambulance services to County Exclusive Operating Area (EOA). 3. Ensure an EMS System that is clinically and operationally excellent as well as financially viable. Implement contracts for fire department based ambulance services. Implement successor contracts for First Responder Advanced Life Support (FRALS) services. 4. Decrease Ambulance Offload Time (APOTZ; transfer of care of patients from 911 ambulances to emergency departments to transpire no later than thirty (30) minutes following the arrival of the ambulance; Monitor First Watch Hospital Offload Dashboard and further develop analytic tools for Ambulance Patient Offload Delays (APOD) 5. Monitor and evaluate 911, FRALS, ACRECC and hospital contract compliance. 6. Strengthen system-wide MCl/disaster/surge capability and capacity; ensure robust planning, training and risk mitigation with focus on vulnerable populations. 7. Strengthen Alameda County MHOAC Manual with Incident Response Guides and supporting medical surge plans, communications, and information management infrastructure. Conduct exercises with focus on health care facility, first responder, BLS and ALS integration. Maximize partnership with Alameda County Health Care Services Agency Divisions -Behavioral Health Care, Public Health and Environmental Health. 8. Continued enhancement of quality improvement programs including those associated with pediatric, cardiac, stroke and trauma specialty care systems • SHORT-RANGE PLAN -Work with emergency medical dispatch centers regarding education and specific QA/QI for calls that are or could be cardiac arrest and warrant Dispatch Assisted Pre-Arrival CPR and AED instructions. 9. Engage in community partnerships facilitating intervention and more comprehensive service delivery to at-risk populations to include children, seniors, as well as those with functional and/or behavioral health care needs. 10. Continue to participate in and host the Regional Trauma Care Committee and EMSC, Pediatric Readiness, and Surge Advisory Committee with UCSF Benioff Children's Hospital • Conduct pediatric readiness hospital site visits and designated pediatric receiving centers consistent with CA EMSC Regulations. Strengthen the program consistent with regulations approved. • Develop a prehospital pediatric training plan with UCSF Benioff Children's Hospital. • Continue to promote the TRAIN Model with focus on NICU. 11. Continue to lead (host) and/or participate in the State, Regional and local Disaster Committees to include: • Regional: -Lead (host) Region 2 MHOAC Committee; participate on Association of Bay Area Health Officers (ABAHO), and UASI Emergency Management and Medical Surge Workgroup; lead Ebola/ Infectious Disease Workgroup • State -Participate in the Patient Movement, California Medical/Health Emergency Operations Manual Committee and Workgroups; California CDPH/EMSA Pediatric Surge Committee and EMS Sub-Committee 12. Continue field use of TXA. Page 27 EXECUTIVE SUMMARY SECTION 4- 2018-19 WORKPLAN NEW 13. Enhance preparedness to respond to multiple casualty incidents given reality of Hybrid Targeted Violence, Active Shooters, terrorism, and multi-site coordinated attacks. • Strengthen triage, patient tracking, and patient movement functions while simplifying workflow for responders. • Deploy additional MCI Deployment Modules with Point of Wounding/Triage response packs across system. Continue development of Tactical EMS and Rescue Task Force programs. Continue to design and implement Public Access Hemorrhage Control program. • Enhance ReddiNet capabilities and facilitate training for all EMS system partners • Strengthen Medical Surge Hospital Bed Expansion Capability and process for a surge of patients 14. Provide opportunities for EMS training to high risk communities • EMS Corps -Short term plan: improve follow-up with and support of alumni • EMS Corp -Long term plan: Develop alumni to regularly assist in EMT training; develop EMT refresher and skills classes to be available for a nominal fee; develop program to include young women of color; develop ongoing mentorship program. 15. Provide Domestic Violence (DV) Awareness, Policy, and Training • Short Term: Improve EMS awareness of DV and impact on community health; Evaluate and adjust DV policy and procedures for telephone referrals as may be necessary; Improve EMS provider documentation related to DV; Improve data collection related to DV; • Long-term: Increase EMS identification of DV victims (through data collection); Increase referrals from the field to DV services (through data collection). Receive regular, appropriate feedback related to referrals; and decrease incidents of death and disability from DV 16. Strengthen EMS Paramedic Preceptor program: Short term plan: Implement policy details, acknowledging expected confusion and delays associated with new standards; Improve communication with preceptors, providers and paramedic training programs; Long term plan: Improve paramedic preceptor performance; Improve paramedic preceptor professionalism; and Improve paramedic preceptor accountability 17. Continue HeartSAFE project with community AED maintenance and provide AEDs for law enforcement vehicles as financially feasible. 18. CATT Team —Plan development of appropriate care of our community's 5150 patients. NEXT PAGE Page 28 EXECUTIVE SUMMARY SECTION 4- 2018-19 WORKPLAN NEW MAJOR PROGRAM SOLUTIONS: Changes and enhancements that will strengthen the EMS system are outlined below. VISION • Identify and continue to implement solutions consistent with the Triple Aim of the Institute for Healthcare Improvement • Promote "Whole Person Care" approach within Alameda County EMS system; continue to collaborate with and integrate services provided by the County Behavioral Health Care Services Agency. SYSTEM OPERATIONS AND REGULATORY REQUIREMENTS 911 CONTRACTS • Ensure system sustainability and continuity • Implement new and/or extend existing contracts as necessary and appropriate. QUALITY IMPROVEMENT • Strengthen continuous quality improvement program on an ongoing basis. • Emergency Department Pediatric "Readiness" -Conduct Site Visits, customized evaluations, and follow-up visits for hospitals in 2018 and 2019. Renew agreement with UCSF Benioff Children's Hospital. • Update Pediatric Medical Surge Plan pending CDPH/EMSA Pediatric Surge recommendations and consistent with CA EMS for Children Regulations. DATA SOLUTIONS • Enhance Bi-Directional Data Sharing Capabilities -amongst Dispatch Centers, First Responder, Transport Providers and hospitals —Leverage HL7 compliant software systems to get EMS data into hospital data systems and get outcome data out of hospital systems. POLICY • Facilitate EMS new policy/procedure update —Disseminate annual information update; conduct training EMERGENCY PREPAREDNESS AND RESPONSE DISASTER SURGE /MCI -RESOURCES • Strengthen MCl/disaster response resource capability and capacity. • Build mass casualty module resource inventory with the MCI Deployment modules. DISASTER COMMUNICATIONS • Ensure interoperable and redundant disaster communications -Strengthen infrastructure and interoperable and redundant communications. • Expand participating partner access and training on ReddiNet and EBRCSA public safety radio communications system. • Ensure ReddiNet System upgrades and training for Health Care system disaster planning coalition partners. Page 29 EXECUTIVE SUMMARY SECTION 3-- 2078-19 WORKPLAN NEW DISASTER PLANS • Contribute to HPP Workplan Medical Surge Deliverables with National 2018-19 benchmarks. • Finalize the Alameda County MHOAC Manual and Incident Response Guides. • Develop a pediatric medical surge hospital expansion framework planning methodology for increasing bed capacity for critical care patients based on CDPH/EMSA Pediatric Surge recommendations. • Expand transportation options to assist in facilitating hospital expansion and decompression of Operational Area (OA) during a medical surge event (i.e. Co-Location Clinic Field Treatment Site Project and Coalition Surge Test Evacuation test). DISASTER TEAMS • Strengthen, implement, and maintain the quarterly Region II RDMHS Ambulance Strike team leader course. • Maintain Alameda County Tactical Emergency Medical Support ITEMS) team and enhance ongoing training. DISASTER TRAINING Strengthen, refine, and ensure continued local and Law Enforcement (POST) approval for the Alameda County EMS 40-hour Tactical Medicine Technician course. • Maintain Alameda County Tactical Emergency Medical Support ITEMS) team and enhance ongoing training Conduct active shooter medical intervention training programs for broad-based first responder participants • Lead the Region II ambulance strike team in disaster response operations as needed MCI POLICIES • Updated and to be implemented with 2020 Protocol/Policy updates. TRANSPORT PROVIDER —PARTNERS • Maximize utilization of Non-Emergency Permitted Ambulance Providers in medical surge events. Ensure communications via ReddiNet and EBRCSA. Re-inspect Non-Emergency Permitted Ambulance Providers as necessary. LOCAL HCSA -EMERGENCY PREPAREDNESS AND RESPONSE • Continue to drive and support Alameda County Health Care Services Agency (HCSA)-level emergency preparedness and response activities including ongoing development and implementation of common emergency radio communications infrastructure across the divisions. LOCAL ALAMEDA COUNTY COALITION —DISASTER PLANNING AND RESPONSE • Promote sustainable relationships and collaborate with Bay Area Operational Area disaster response partners at multiple levels: field, local jurisdiction, OA, and Region. • Participate and support hospital on-site medical surge planning as needed. • Co-facilitate the Alameda County Disaster Planning Health Coalition (DPHC) and Steering Committee with Public Health. • Lead the Health Care Services Agency Disaster Operations Leadership Committee to strengthen disaster response. Page 30 EXECUTIVE SUMMARY SECTION 3- 2018-19 WORKPLAN NEW STATE DISASTER PLANNING • Given that the state and region including EMSA, CDPH, OES, ABAHO and the Bay Area UASI have several ongoing projects to expand surge capacity, ALCO EMS will participate in those efforts. • Continue to Co-Lead the California Neonatal/Pediatric Disaster Coalition • Support the CDPH/EMSA Pediatric Surge Project. • Facilitate planning to support the CA Patient Movement Project with focus on pediatrics. • Participate on the California Patient Movement Committee. REGIONAL DISASTER PLANNING • Strengthen the Region II RDMC/S role. • Lead ongoing Region II Ebola/Infectious Disease Transportation Plan development and implementation. • Promote Regional ReddiNet Coordination through the MHOAC Committee. • Support continued work on the ABAHO -MAC Project and Medical Shelter Support project as needed. • Support the Catastrophic Earthquake Planning using new Hayward Fault scenario. • Participate and support the UASI Medical Shelter and Emergency Management Workgroup. RESEARCH • Promote Patient Care "Best Practices" -Sustain and strengthen research and disseminate information via publications, e,g, continue to collaborate with EOA emergency ambulance services provider on Tactical EMS program as well as first responders on Rescue Task Force program. Beta test new opportunities for service provision to vulnerable populations. • Strengthen EMS System Capability and Capacity to continue research and innovation -Ensure sustainable research funding sources. Seek revenue to enhance already existing programs to conduct approved trials. COMMUNITY -WHOLE PERSON CARE -TRAINING • Continue development and implementation of Pilot Community Assessment, Treatment and Transport program in conjunction with Alameda County Behavioral Health Care Services to enhance services to individuals experiencing mental health crisis in the community and reduce prevalence of 5150 holds. • Recruit Students for EMS Corps Cohort 17 (first co-ed cohort). Partner with San Mateo County to accept four students into the EMS Corps and potentially provide two new employment partners. • Obtain additional funding and support for Health Coach Program. Page 31 A. SYSTEM ORGANIZATION AND MANAGEMENT (2018-19) Does not currently meet standard Meets minimum standard Meets recommended guidelines Short- range plan Long-range plan Agency Administration: 1.01 LEMSA Structure 3 1.02 LEMSA Mission 3 1.03 Public Input 3 1.04 Medical Director 3 3 Planning Activities: 1.05 System Plan 3 1.06 Annual Plan Update 3 3 1.07 Trauma Planning* 3 3 3 3 1.08 ALS Planning* 3 3 3 1.09 Inventory of Resources 3 3 1.10 Special Po ulations 3 3 3 3 1.11 System Partici ants 3 3 3 3 Regulatory Activities: 1.12 Review & Monitorin 3 3 3 1.13 Coordination 3 1.14 Policy & Procedures Manual 3 3 1.15 Compliance w/Policies 3 3 System Finances: 1.16 Funding Mechanism Medical Direction: 1.17 Medical Direction* 3 3 3 1.18 QA/QI 3 3 3 3 1.19 Policies, Procedures, Protocols 3 3 3 Page 128 A. SYSTEM ORGANIZATION AND MANAGEMENT (continued) Does not currently meet standard Meets minimum standard Meets recommended guidelines Short-range plan Long-range plan 1.20 DNR Policy 1.21 Determination of Death 3 1.22 Reporting of Abuse 3 1.23 Interfacility Transfer 3 3 Enhanced Level: Advanced Life Support 1.24 ALS Systems 3 3 3 1.25 On-Line Medical Direction 3 3 3 3 Enhanced Level: Trauma Care S stem: 1.26 Trauma System Plan 3 Enhanced Level: Pediatric Emer enc Medical and Critical Care S stem: 1.27 Pediatric System Plan 3 3 3 Enhanced Level: Exclusive O eratin Areas: 1.28 EOA Plan 3 ~ Page 129 B. STAFFING/TRAINING Does not currently meet standard Meets minimum standard Meets recommended guidelines Short-range plan Long-range plan Local EMS Agency: 2.01 Assessment of Needs 3 3 3 2.02 Approval of Trainin 3 3 2.03 Personnel 3 3 3 Dispatchers: 2.04 Dispatch Trainin 3 3 3 First Responders (non-transporting): 2.05 First Responder Trainin 3 3 2.06 Response 3 3 3 2.07 Medical Control 3 3 3 Transporting Personnel: 2.08 EMT-I Training 3 3 Hospital: 2.09 CPR Training 3 3 2.10 Advanced Life Su ort 3 3 Enhanced Level: Advanced Life Support: 2.11 Accreditation Process 3 3 2.12 Early Defibrillation 3 3 3 2.13 Base Hospital Personnel 3 3 3 Page 130 C. COMMUNICATIONS Does not currently meet standard Meets minimum standard Meets recommended guidelines Short- range plan Long- range plan Communications Equipment: 3.01 Communication Plan'` 3 3 3 3.02 Radios 3 3 3.03 Interfacility Transfer* 3 3.04 Dispatch Center 3 3.05 Hospitals 3 3 3.06 MCl/Disasters 3 3 Public Access: 3.07 9-1-1 Planning/ Coordination 3 3 3 3.08 9-1-1 Public Education 3 Resource Management: 3.09 Dispatch Triage 3 3 3 3 3.10 Integrated Dispatch 3 3 Page 131 D. RESPONSE/TRANSPORTATION Does not currently meet standard Meets minimum standard Meets recommended guidelines Short- range plan Long- range plan Universal Level: 4.01 Service Area Boundaries* 3 3 3 4.02 Monitoring 3 3 4.03 Classifying Medical Re uests 3 3 4.04 Prescheduled Res onses 3 3 4.05 Response Time* 3 3 4.06 Staffing 3 4.07 First Responder A encies 3 3 4.08 Medical &Rescue Aircraft* 3 4.09 Air Dispatch Center 3 4.10 Aircraft Availabilit 3 4.11 Specialty Vehicles" 3 4.12 Disaster Response 3 3 3 4.13 Intercounty Res onse* 3 3 4.14 Incident Command S stem 3 3 3 4.15 MCI Plans 3 3 Enhanced Level: Advanced Life Support: 4.16 ALS Staffing 3 3 4.17 ALS Equipment 3 Enhanced Level: Ambulance Regulation: 4.18 Compliance ~ Enhanced Level: Exclusive Operating Permits: 4.19 Transportation Plan 3 4.20 "Grandfathering" 3 4.21 Compliance 3 4.22 Evaluation 3 3 Page 132 E. FACILITIES/CRITICAL CARE Does not Meets Meets Short-range Long-range currently minimum recommended plan plan meet standard guidelines standard Universal Level: 5.01 Assessment of 3 3 Ca abilities 5.02 Triage &Transfer 3 Protocols* 5.03 Transfer 3 Guidelines* 5.04 Specialty Care 3 3 Facilities* 5.05 Mass Casualty 3 3 3 Mana ement 5.06 Hospital 3 3 Evacuation* Enhanced Level: Advanced Life Support: 5.07 Base Hospital 3 Desi nation'` Enhanced Level: Trauma Care System: 5.08 Trauma System 3 Desi n 5.09 Public Input 3 Enhanced Level: Pediatric Emergency Medical and Critical Care System: 5.10 Pediatric System 3 Desi n 5.11 Emergency 3 3 3 De artments 5.12 Public Input 3 Enhanced Level: Other Specialty Care Systems: 5.13 Specialty System 3 3 3 Desi n 5.14 Public Input 3 Page 133 F. DATA COLLECTION/SYSTEM EVALUATION Does not Meets Meets Short-range Long-range currently minimum recommended plan plan meet standard guidelines standard Universal Level: 6.01 QA/QI Program 3 3 3 3 6.02 Prehospital 3 3 3 Records 6.03 Prehospital Care 3 3 Audits 6.04 Medical Dispatch 3 3 6.05 Data Management 3 3 S stem* 6.06 System Design 3 Evaluation 6.07 Provider 3 Partici ation 6.08 Reporting 3 Enhanced Level: Advanced Life Support: 6.09 ALS Audit 3 3 Enhanced Level: Trauma Care System: 6.10 Trauma System 3 3 Evaluation 6.11 Trauma Center 3 3 3 Data Page 134 G. PUBLIC INFORMATION AND EDUCATION Does not Meets Meets Short-range Long-range currently meet minimum recommended plan plan standard standard guidelines Universal Level: 7.01 Public Information 3 3 3 3 Materials 7.02 Injury Control 3 3 3 3 7.03 Disaster 3 3 Pre aredness 7.04 First Aid &CPR 3 3 Training Page 135 H. DISASTER MEDICAL RESPONSE Does not currently meet standard Meets minimum standard Meets recommended guidelines Short- range plan Long-range plan Universal Level: 8.01 Disaster Medical Plannin 3 3 8.02 Response Plans 3 3 8.03 HazMat Training 3 3 3 8.04 Incident Command S stem 3 3 8.05 Distribution of Casualties* 3 3 8.06 Needs Assessment 3 3 8.07 Disaster Communications* 3 3 8.08 Inventory of Resources 3 3 8.09 DMAT Teams 3 3 8.10 Mutual Aid A reements* 3 8.11 CCP Designation* 3 3 8.12 Establishment of CCPs 3 8.13 Disaster Medical Trainin 3 3 8.14 Hospital Plans 3 3 8.15 Interhospital Communications 3 3 8.16 Prehospital Agency Plans 3 3 3 Enhanced Level: Advanced Life Support: 8.17 ALS Policies 3 3 Enhanced Level: Specialty Care Systems: 8.18 Specialty Center Roles 3 Enhanced Level: Exclusive Operating Areas/Ambulance Regulations: 8.19 Waiving Exclusivit 3 Page 136 LEMSA: ALAMEDA COUNTY FY: 2018-19 9~~8~~9 'V d y N ~ l4 Q ~ ~ d 'c ~ = R `o C T t0 _ ~ ~ ~ d ~ ~ ~ ~ Progress — 2018 Objective — 2018-19 R W = y •~ ~ a> p~ w UPDATED 9118/19 N ~ d~ y w j 0 g o E A. System Organization and Management -Agency Administration: 1.01 LEMSA ~ PROGRESS TO DATE: Each local EMS agency shall have a formal organization Structure EMS ORGANIZATION structure which includes both agency staff and non-agency • Alameda Gounty (ALCO) EMS is a division of the Alameda County Health Care resources and which includes appropriate technical and clinical Services Agency (HCSA). Transitions continue to occur within HCSA leadership. expertise. EMS STAFFING AND PROGRAM CHANGES OBJECTIVE: • Refer to the EMS Director, General Administration and Staffing changes below. Ensure formal EMS organization with technical and clinical EMS DIRECTOR AND DEPUTY DIRECTOR expertise and competency. • LAURI MCFADDEN, EMS Director, (hired 2019) reports directly to Colleen Chawla, Agency Director of the Alameda County Health Care Services Agency. (Refer to the EMS System plan Table 2 for the updated • ANNE KRONENBERG was hired as Interim EMS Director in October 2018 and Alameda County EMS Organization Chart) served in that capacity until Lauri McFadden was hired in April 2019. Anne is remaining with the Agency as a consultant to oversee special projects to include the next EMS system RFP process. • WILLIAM MCCLURG, an EMS Coordinator for the Agency, was promoted to EMS Deputy Director in 2019. RDMHS • ARAM BRONSTON was hired November 2019 to serve as the Region II RDMHS. EMS COORDINATORS • YOLANDA TAKAHASHI. EMS Coordinator, Liaison for Primary EOA Provider and Project Lead with Behavioral Health and the current 9-1-1 provider to develop the Community Assessment and Transport Team.(hired April 2019) • LESLIE SIMMONS, EMS Coordinator (hired July 2019) Liaison with Receiving Hospitals and BLS/IFT Providers GENERAL ADMINISTRATION • ERICA CAMPOS was promoted to support the EMS Director • WILLIAM TUTOL was hired as Administrative Specialist II EMS FUNCTIONAL ORGANIZATION • As the Director, Lauri McFadden is responsible for ensuring the ongoing planning, implementation and evaluation of the local EMS system, and ensures the local /regional medical coordination during a disaster. • The EMS Deputy Director, EMS Medical Director and EMS Coordinators (previously PHCC) team provide essential support to the Director. Finance, Budget, and Administrative leadership staff support at the HCSA level as EMS continues to evolve. • ALCO EMS continues the internal reorganization based upon the core functional areas of Finance and Administration, System Operations and Regulatory Compliance, Emergency Preparedness and Response, Injury Prevention and Career and Workforce Development programs. The EMS program scope includes community education; simple and complex training programs; incident planning and management; emergency dispatch standards; data collection; quality improvement; statute, policy and regulation enforcement; EMS personnel certification; investigations; management of specialty care programs including hospital-based specialty care components (i.e. Cardiac, Stroke, Trauma, and raye x C 3 w Ey d N R°' d ld zi. R 'o Q E v~ ` ~ d ~ ~ ~ `m ~ ~ Progress - 2018 Objective 2018-19 z R g ._ = _ ~ a~ m p~ ~ UPDATED 9/18/19 - W ~ N ~ ~ai ~ ~ y a> p ~' 0 J ~ ~ pediatrics), disaster preparedness, and hospital -EMS integration). NEXT PAGE 1.02 LEMSA ~ Refer to the QI Plan 2019 and the EMS System Plan Update 2017. OBJECTIVE: Mission To ensure EMS Plan, implementation, and evaluation of PROGRESS TO DATE: the EMS system • Alameda County EMS has adopted and continues to strive towards the National pLAMEDA COUNTY (ALCO) EMS VISION Highway Tragic Safety Administration (NHTSA) vision described in the "EMS VISION Helping people live healthy and fulfilling lives Agenda for the Future." Given the vision, Alameda County EMS continues to through training, preparedness, prevention, and medical leverage partners for effective outcomes: response. o Alameda County EMS facilitates collaboration with stakeholders and partners MISSION Alameda County EMS ensures the provision of (public and behavioral health as priorities), propagating a flexible system that quality emergency medical response services and continuously adapts to the changing healthcare environment. prevention programs to improve health and safety in o Collectively, Alameda County EMS is delivering services that are consistent Alameda County. with the Institute for Healthcare Improvements "Triple Aim"of: VALUES ALCO EMS values a caring environment Improving the patient experience of care (including quality and sustained by empowerment, honesty, integrity and mutual satisfaction) Improving the health of populations; and respect. We embrace excellence through innovation, Reducing the per capita cost of healthcare teamwork and community capacity building. Refer to EMS Website: Refer to the "EMS Agenda for the Future." vision below: http://ems.acgov.orq/AboutEMSAgencVlAboutEMSAqency.page? "Emergency medical services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care Cont. " Page 33 ~ ~ £ N y .-. R ~ ~ ~ ~ N ~ OI N ~ ~ _ Q~ ~ ~ ~ ~ o~ ~o ~ ~ pro ress — 2018 9 Objective — 2018-19 ~p W = y ~ ~ a~ p~ ~ UPDATED 9/18/19 N ~ d ~ y a> p ~' 0 ~ ~ J ~ ~ ~~2 LEMSA ~ Refer to 2017 EMS System Plan Update Each local EMS agency shall plan, implement, and evaluate Mission PROGRESS TO DATE: the EMS system. The agency shall use its quality In July 2015. the Alameda County EMS Agency (ALCO EMS) began preparing to release assurance/quality improvement (QA/QI) and evaluation a RFP for 911 emergency ambulance services, with the goal of ensuring an EMS System processes to identify system changes. that is clinically and operationally excellent as wel! as financially stable: • OVERARCHING GOALS o Sustain and improve quality of clinical care the patient receives o Stabilize or reduce the cost of EMS services (financial stability) o Improve patient satisfaction EMERGENCY AMBULANCE SERVICES -CONTRACTS • ALCO EMS conducted a competitively bid RFP process, to select and implement a contract for services to the Exclusive Operating Area (EOA) served by Paramedics Plus prior to June 30. 2019. Of the three proposals received, Falck was selected as the new EOA provider. • 9-1-1 emergency ambulance transport transition occurred over a 6 month process after the Agreement was finalized on December 14, 2018. Falck assumed EOA transport responsibility from Paramedics Plus on July 1, 2019 FRALS, FIRE AMBULANCE TRANSPORT &MEDICAL DISPATCH SERVICE • New ALS ambulance transport agreements with the cities of Alameda, Albany, Berkeley, and Piedmont were approved by the County Board of Supervisors and executed providing for service through June 30, 2024, each with an option to extend for an additional five (5) year period. • First Responder Advanced Life Support (FRALS) agreements County-wide provide for service through June 30, 2024, each with an option to extend for an additional five (5) year period. • The Emergency Medical Dispatch agreement with the Alameda County Regional Emergency Communications center provides for service through June 30, 2024 and contains options to extend thereafter. 1.03 public Input ~ Refer to 2017 EMS System Plan Update Each local EMS agency shall have a mechanism (including PROGRESS TO DATE: EMCCs and other sources) to seek and obtain appropriate • Various committee collaborations are continuing to ensure public input and EMS consumer and health care provider input regarding the agency representation as follows: EMS Quality Council; Emergency Medical development of plans, policies and procedures, as described Oversight Committee EMOC; Receiving Hospital Committee; STEMI Committee; in the State EMS Authority's EMS Systems Standards and Stroke Committee; Trauma Audit Committee; Regional Trauma Audit Committee: Guidelines. Data Steering Committee; ePCR Change Committee; EMS Section Chiefs Committee; Alameda County Fire Chiefs Committee; EMSAAC/EMDAAC; LEMSA OBJECTIVE: Coordinators Meeting; EMSC, QI, &Pediatric Surge Advisory Committee Meeting, Continue obtaining input from consumer and healthcare and other ad-hoc committees (ie. EMS Transition Meetings; ReddiNet and Western partners. Regional Alliance for Pediatrics Emergency Management (WRAP-EM) Workgroup Committee) Hostin of ublic comment forum for ro osed annual rotocol and olic u dates 1.04 Medical 3 Refer to 2017 EMS System Plan Update Each local EMS agency shall appoint a medical director who Director PROGRESS TO DATE: is a licensed physician who has substantial experience in the • Dr. Karl Sporer continues to serve as the EMS Medical Director practice of emergency medicine. • Dr. Jocelyn Garrick continues to serve as the Deputy EMS Medical Director. OBJECTIVE: EMS FELLOWS Continue with the current staffing for EMS Medical • Alameda County EMS has a contract with the University of California, San Francisco Director, Deputy EMS Medical Director, and EMS (UCSF) Department of Emergency Medicine to provide the opportunity for their Fellows Page 34 C ~ r N ~ ~ d f6 R Q~ ~c E R o {6 z ~ ~ ~ ~ ~ '~ p~ ~ Progress - 2018 UPDATED 9!18119 Objective - 2018-19 R W 3 3 a> p~ ~ N ~ ~~ y ~ o j o E physicians to participate in an EMS Fellowship. The purpose of the EMS Fellowship program is to provide the physicians exposure to EMS, providing them insight and knowledge of prehospital medical care and the functionslcoordination of an EMS system. Reports to Medical Director —The Fellows are listed below: o LAUREN HART, Current EMS UCSF Fellow o JEREMY LACOCQUE, Current EMS UCSF Fellow o SAMMY HODROGE EMS UCSF Fellow (Q3 & Q4 2018) Completed Airway QI project; worked on Respiratory Distress manuscript; Lectured at Bay Area Paramedic Journal Club MEDICAL DIRECTOR RESEARCH • Karl Sporer, MD, Medical Director with Agency Staff continues submission of both peer reviewed and non-peer reviewed research which is published in highly respected professional journals and periodicals • Tseng ZH, Olgin JE, Vittinghoff E, Ursell PC, Kim AS, Sporer K, Yeh C, Colburn B, Clark NM, Khan R, Hart AP, Moffatt E. Prospective Countywide Surveillance and Autopsy Characterization of Sudden Cardiac Death: POST SCD Study. Circulation. 2018 Jun 19;137(25):2689-2700 • Trivedi TK, Glenn M. Hern G, Schriger DL, Sporer KA. Emergency Medical Services Use Among Patients Receiving Involuntary Psychiatric Holds and the Safety of an Out-of-Hospital Screening Protocol to "Medically Clear" Psychiatric Emergencies in the Fieid, 2011 to 2016. Ann Emerg Med. 2018 (18)31158-2. • Backer HD, D'Arcy NT, Davis AJ, Barton B, Sporer KA Statewide Method of Measuring Ambulance Patient Offload Times. Prehosp Emerg Care. 2018 Sep 26:1- 18. • Neeki MM, Dong F, Toy J, Vaezazizi R, Powell J, Wong D, Mousselli M, Rabiei M, Jabourian A, Niknafs N, Burgett-Moreno M, Vara R, Kissel S. Luo-Owen X, O'Bosky KR, Ludi D, Sporer K, Pennington T, Lee T, Borger R, Kwong E. Tranexamic Acid in Civilian Trauma Care in the California Prehospital Antifibrinolytic Therapy Study. West J Emerg Med. 2018 Nov;19(6):977-986. doi: 10.5811/westjem.2018.8.39336. Epub 2018 Sep 10 .-tanning Activities: 1.05 System Plan 3 Refer io 2017 EMS System Plan Update Each local EMS agency shall develop an EMS System Plan, PROGRESS TO DATE: based on community need and utilization of appropriate CA EMSA APPROVAL -SYSTEM PLANS AND REGULATORY COMPLIANCE resources, and shall submit rt to the EMS Authority. EMS SYSTEM PLAN Objective: EMS System Planning • Alameda County 2017 EMS System Plan Update (with 2017-2018 Executive NEW OVERARCHING GOALS Summary) completed and approved by the California EMS Authority; Sustain and improve quality of clinical care the patient 2018 Update submitted to EMSA September 2019 receives EMS TRAUMA PLAN • Stabilize or reduce the cost of EMS services • Improve patient satisfaction • Alameda County 2017 EMS Trauma Plan Update and approved by CA EMSA; 2018 SIX FUNDAMENTAL TENANTS • Update submitted to EMSA September 2019 1. Preserving a high level of emergency medical response EMS QUALITY IMPROVEMENT IQI) PLAN throughout the County 2. Producing a system that is cost-effective while • 2018 Update submitted to EMSA September 2018 preserving a high level of response and care • 2019 Update submitted to EMSA September 2019 3. Designing a system that is County-wide (ie. Current EMS FOR CHILDREN (EMSC1 PLAN Exclusive Operating Area (EOA) allowing for Page 35 'o c m E N ~ d N °' d m R Q ~ £ a~i ~c E z R `o = i. t~ '-_ ~ ~ ~ d oC ~ ~ ~ Progress - 2018 Objective - 2018-79 W a~ pJ ~ UPDATED 9/18119 N d d' a' m ~ d' t aTi N o p ~' J E • Plan to submit EMSC Plan to EMSA by January 2020 consistent with new CA EMSC consistency of service Throughout all areas and regulations. Finalizing hospital agreements to ensure hospitals implement PedRC jurisdictions of the County requirements. 4. Maintaining and supporting the current workforce Refer to 1.02 Progress Update Form 5. Producing a system that is sustainable for the long term EMS SYSTEM Evaluation and Request for Proposals (RFP) 6. Maintaining the appropriate regulatory and oversight • ALCO EMS conducted a RFP process, to select and implement a contract for functions between the local EMS agency (LEMSA) and the chosen providers) services to the Exclusive Operating Area (EOA) o Paramedics Plus contract ended June 30, 2019. • Falck is the newly selected ALCO EMS 911 Provider as of Juty 1, 2019. o Emergency Ground Ambulance Service will be provided through June 30, 2024 • EMS executed the Falck contract, ensuring contract compliance and oversight CONTRACT Extensions &New Contracts-FRAYS and FIRE TRANSPORT • Alameda Countv Regional Emerpencv Communications Center (ACRECC) emergency medical dispatch -executed new contract effective until June 30, 2024 • First Responder Advanced Life Support (FRALS) and Fire Transport -negotiated and executed new contracts effective until June 30, 2024 1.06 Annual Plan 3 3 Refer to 2017 EMS System Plan Update Each local EMS agency shall develop an annual update to its Update PROGRESS TO DATE: EMS System Plan and shall submit it to the EMS Authority. • EMS System Plan Update for 2017-18 completed and submitted in August 2018 and The update shall identify progress made in plan approved September 2018. implementation and changes to the planned system design OBJECTIVE: Update the EMS System Plan yearly or as rescribed and submit to EMSA short ran e 1.07 Trauma 3 ~ ~ Refer to 2017 EMS System Plan Update The local EMS agency shall plan for trauma care and shall Planning' PROGRESS TO DATE: determine the optimal system design for trauma care in its • ACS Certification is now a requirement of current Trauma Center contracts jurisdiction. New contracts implemented in 2018. EMS planned for verification and reverification OBJECTIVE: The purpose of the trauma plan is to monitor visits by the American College of Surgeons for the County's 3 trauma centers. the delivery of services, improve trauma care through use of n Alameda Health System -Highland Hospital successfully achieved Level 1 status in best practice in reducing death and disability, and identify April 2017 following ACS consultation in May 2016 in which Alameda County EMS areas where improvement can be made. leadership participated. Short-Range Plan: • All trauma centers successfully completed scheduled ACS re-verification April 2017: • Maintain ACS Verification as a requirement of the contracts with our trauma centers. o UCSF Benioff Children's Hospital Oakland, Level 1-Pediatric Lonq Range Plan o Alameda Health System -Highland Hospital, Level 1-Adult " Completion of a System-Wide Trauma Evaluation by the o Sutter Eden Medical Center, Level 2-Adult ACS --~"-----~~~~~-- Short Range Plan: • ALCO EMS continues to participate in and host the Regional Trauma Coordinating Improve the functionality of our Trauma Audit Committee Committee (RTCC). by adding apre-TAC component. Improve our analysis TRANEXAMIC ACID (TXA) Pilot Studv and Adoption in Optional Scope of existing trauma data. ALCO EMS participation in TXA pilot study ended in fall of 2017 and continued field Short Range Plan: use of TXA awaiting state approval for optional scope which occurred in June 2018. Renew Trauma Contracts with ALL three existing • Following the conclusion of this Pilot study of IV administration of TXA to control life- Alameda County Trauma Centers for another THREE threatening hemorrhage, TXA is now part of our local optional scope of practice in year term (2018-2021). Alameda County. ~ •~$ ALS Planning' 3 3 ~ Refer to 2017 EMS System Pfan Update Each local EMS agency shall plan for eventual provision of PROGRESS TO DATE: advanced life support services throughout its jurisdiction. Page 36 '~ C d y = d H ~) c6 R Q ~ ~ d 'c E C~ R `o C T {a ~-_ ~ ;! ~ OC ~ p~ ~ Progress - 2018 Objective - 2018-79 ~p W = '~ ~ a~ p1 ~ UPDATED 9/18!19 N ~ m ~ y ~ j ~' 0 ~ o ~ • Advanced Life Support has been available county-wide since 1986. Advanced Life OVERALL OBJECTIVES: Support available on first response vehicles county-wide since 2011. Medical Priority Ensure seamless delivery of 911 services to the citizens Dispatch (MPDS) has been implemented in over 90% of the system. of Alameda County by integrating all FRALS providers • Until June 30, 2019, the contract allowed the use of BLS for all Omega, Alpha and into one contract template. Bravo calls. Paramedics Plus utilized BLS for Omega, Alpha and 4 specific Bravo Utilize evidence based process to tailor ALS response to calls only in the north part of the county. provide enhanced focus on high acuity patients. • From July 1, 2019 moving forward, call determinants have been further categorized Reconfigure resource contingent assigned to low acuity into priorities. The new priority system has 5 response priorities: patients. Utilize a stakeholder based workgroup process o Priority 1 —High Acuity Calls -Code 3 response by FRALS, ALS transport to facilitate. and EMS Supervisor SHORT-RANGE PLAN: o Priority 2 —Moderate Acuity Calls -Code 3 response by FRALS and ALS Development of the work group. transport LONG-RANGE PLAN: o Priority 3 —Emergent Interfacility —Code 3 ALS transport (Code 3 FRALS MPDS in 100% of the system with assigned response as needed) contingents defined on an ongoing basis to match o Priority 4 —Low Acuity Calls —Code 2 ALS or BLS transport. (FRALS at patient needs in an evidence based manner. discretion of each agency) o Priority 5 —Non-medical 5150 —Code 2 AL5 or BLS transport OR Approved alternative • Data driven approach to response patterns implemented. • ALCO EM5 partnered closely with ALCO EMS approved ACE Accredited EMD centers (Oakland Fire Department (OFD) and Alameda County Regional Emergency Communications Center (ACRECC) as well as the International Academies of Emergency Dispatch (IAED) to prudently and in evidence based manner rectify a situation that materialized as a result of Version changes in the MPDS system which produced substantially more ECHO level respiratory responses which did not correlate with the expected clinical acuity in our system and other large systems world-wide. 1.09 Inventory of 3 3 Refer to 2017 EMS System Plan Update Each local EMS agency shall develop a detailed inventory of Resources PROGRESS TO DATE: EMS resources (e. g., personnel, vehicles, and facilities) RESOURCE DIRECTORIES: within its area and, at least annually, shall update this COMMUNICATION SYSTEMS inventory. • EMAIL Distribution Lists updated for: Health Care Services Agency (HCSA) OBJECTIVES: leadership emergency notification; Falck 911 and non-emergency permitted SHORT RANGE Ambulance providers. Pediatric Emergency Care Coordinators (PECCs) identified for ~ Update the Resource Directory annually and submit all pediatric receiving centers (PedRC) hospitals; contact list updated.. EMS System Plan tables to EMSA annually. Coordinate • REDDINET -Updated Master ReddiNet Contact List. Added new users. Created ab with the RDMHS to ensure resources updates are EMS System Notification Distribution List {Receiving Hospitals, Fire Departments, included in the metrics information management system 911 Providers, and Non-Emergency Permitted Providers data. • AC Alert - HCC Coalition member distribution list updated Coordinate with the ReddiNet Coordinator and HPP • CAHAN distribution lists updated including transport providers EMSA Coordinator to ensure disaster contacts are VEOCI —RESOURCE MANAGEMENT SYSTEM updated in ReddiNet and HPP Disaster Preparedness • Public Health and OES utilize VEOCI for disaster resource management. EMS will Coalition Master Distribution List. evaluate utilization and consistency with Alameda County GSA resource Ensure CAHAN, AC Alert, and ReddiNet contacts management. updated FACILITIES: • Ensure resource deployment resources and location for supplies updated including MCI Deployment Modules • Office of Homeland Security and Emergency Services utilizing ReddiNet contact information to map GIS hospital, clinic, SNF, and other HCF locations • General Services Agency —Updated logistics Resource Inventories includes OA GIS Maps and Facilities. (focus Veoci Resource Management System) TRANSPORT PROVIDERS &EMS Page 37 '~ R _ !0 N 41 Q~ ~ ~ W 7 ~ CG ~ ~ d ~c ~ ~ ~ y 3 d~ ~ N C ~ R `o ~ ~ ~ a~ y~ o OI N R T pC ~ pf w j o ~ Progress — 2018 UPDATED 9/18/19 Objective — 2018-19 • After transition to Falck, updated all contact directories • Ensure communications device for EMS Command Vehicles EQUIPMENT AND SUPPLIES -Updated MCIIMASS CASUALTY DEPLOYMENT MODULES/TRAILERS • Six MCI Deployment Modules purchased in June 2018 for existing MCI trailers with POW response kits and DMS command supplies. Modules distributed throughout Alameda County including Falck and clinic locations. • Several clinics have received training and Point of Wounding kits. • Alameda County EMS Resource Directory distribution lists -updated with new MCI modules. GENERAL SERVICES AGENCY • Updated Logistics Equipment and Supply Resource Inventories with Public Health • Private Sector Logistics Inventory Updated with General Services Agency • Alameda County Public Health DepartmenUEMS Resource Inventories —ACS Cache — MOUs Updated using Veoci EMS EMERGENCY/DISASTER SUPPLY INVENTORY • Updated inventory list using Falck for resource locations • 700!800 Megahertz UHFlVHF Portable Radios updated inventory and distribution list • Portable laptops —New equipment inventoried and updated • Ensuring increased availability of mobile disaster response communication and information management systems. Alameda County EOC Medical/Health Branch and EMS DOC priority assets and resources identified OPERATIONAL AREA EOC MEDICAL / HEAITH BRANCH AND EMS DOC • ALCO EMS collaborated with the Sheriff's Department Once of Emergency Services and Homeland Security to upgrade the operational area EOC Medical/Health Branch enhancing physical space functionality and technology assets. Planning to relocate EOC Med/Health Branch to a larger room. • EMS Branch DOC upgrades planned. Developed plans to update EMS DOC technology and logistics requirements in San Leandro. • Tested EMS Branch DOC in the Falck Transition June 30, 2019 and Coalition Surge Test May 30, 2019; June 27, 2018 MOBILE /OFF-SITE OPERATIONAL CAPABILITY • Inventoried and assigned new radios to EMS Coordinators • Ensure all EMS Personnel have APX-7000 radios, mics, batteries and chargers. Updated communications cache. Designated ALCO EMS Duty Officers have new programmed individually issued 700/800Mhz &VHF portable radios • EMS Director, EMS Deputy Director and EMS Coordinators have mobile laptops with extended life batteries and enhanced connectivity to ensure operational self- sufficiency, reliable communications and information management capability. • EMS Director, EMS Deputy Director, MHOAC and RDMHS Region II have new satellite communications voice and data devices • All ALCO EMS Duty Officer response vehicles have 700/800Mhz 8~ VHF portable radios and have been equipped with AED's and basic first aid /trauma supplies • Assisted ITD and HCSA with communications and radio inventory for all branches of HCSA (EMS, Behavioral Health, Mental Health, Public Health, and leadership) Page 38 y 3 " ~ y Of N m N 1~6 Q ~ c ~ R o {Lp _ ~ ~ ~ d ~ ~ p~ ~ Progress - 2018 Objective - 2078-19 ~p W = ~ a~ p~ ~ UPDATED 9!18/19 N m d d r a> p ~' 1.10 Special 3 r ~ Refer to 2017 EMS System Plan Update Each local EMS agency shall identify population groups Populations Refer to previous sections and plans: served by the EMS system which require specialized services • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 (e. g., elderly, handicapped, children, non-English speakers). • 5.04 (Specialty Care Facilities) Progress Update Form 2017-18 GOALS OF EMSC IN ALAMEDA COUNTY PROGRESS TO DATE: OVERALL GOAL —LONG-RANGE Children -identified as special population group The overall goal of the emergency medical services for EMS FOR CHILDREN PROGRAM children (EMSC) program is to ensure that acutely ill and • The Alameda County EMS Agency ensures overall EMS for Children system injured children have access to high quality, integration, design, monitoring and quality improvement. coordinated, and comprehensive emergency and critical care services appropriate for children's special needs. The EMSC Coordinator Cynthia Frankel at the Alameda County EMS Agency SHORT RANGE PLAN:/ LONG RANGE provides technical assistance and coordination to ensure integration of EMSC in EMS for Children Program update consistent with CA each Alameda County EMS program and clinical operations. The focus is pediatric EMSC regulations and implement PedRC agreements quality of care, operational field pediatric policies, continuity of care, family-centered care, children with functional needs, injury prevention, and disaster /surge Refer to 2017 EMS Sysrem ~'~~r- t ir;r*:= preparedness and training. PEDIATRIC SURGE GOALS QUALITY IMPROVEMENT - EMSC Right Patient, Right EMS Resource, Right Destination The EMS for Children quality benchmarks and activities reflecting progress include: Ensure the highest and best utilization of and access to • Alameda County EMS has amulti-year contract with the pediatric trauma center our region's pediatric resources UCSF Benioff Children's Hospital, Oakland (Level 1 Trauma Center) for collaboration Leverage and maximize every asset at all levels of to ensure hospital quality improvement for hospital pediatric "day the day" readiness, capabilities at every hospital, large or small, rural or urban, pediatric or adult injury prevention, and disaster /surge capability. A new contract effective January Recognize that a coordinated and integrated response 2019 is now implemented An addendum to contract is planned for prehospital requires the active participation of private and public pediatric training through 2020. resources and systems at every level. • Partnership with UCSF Benioff Children's Hospital, Oakland including the Pediatric Strive to equitably maximize the # of children receiving Readiness ED site visits to ensure "day to day" and surge preparedness. care appropriate for their needs during a disaster • Pediatric quality assurance and improvement process by including outside experts Recognize and acknowledge that in a major event, for performance review of both the trauma centers and receiving hospitals. demand for pediatric care will likely exceed resources and capacity. Op areas, regions, and CA will move from • All pediatric trauma cases including all MCIs are reviewed and monitored. Refer to individual-based care to population-based care with the the 2018-19 EMS Trauma Plan update. focus on saving the maximum # of lives possible. • Alameda County EMS has the quarterly EMS for Children, Pediatric Readiness, QI, Consistent with the California Five Year Plan includes the and Medical Surge Advisory Committee with UCSF Benioff Children's Hospital. The following goals for 2001-2005: next meeting is scheduled October 25, 2019. o Improve data collection and quality improvement The scope of this workgroup supports implementation of the new CA EMS systems, data analysis, and research in EMSC regulations. Planning activities include: leveraging system-wide HCC ~ Integrate pediatric issues in all aspects of EMS development -disaster pediatric coalition response planning partners Pediatric Emergency Care o Expand the availability of illness and injury Coordinators (PECCs); monitoring hospital pediatric readiness with prevention, first aid and CPR programs Emergency Department Pediatric Site Visit Assessments using National Tools; o Optimize pediatric emergency department and planning pediatric exercises and training (ie. SWMHE and CST with pediatric critical care facility capabilities throughout the state considerations; and prehospital pediatric training, o Optimize trauma care for all pediatric patients o Optimize prehospital and inter-facility pediatric PEDIATRIC RECEIVING CENTERS (PedRC) transport M All hospitals are expected to comply with the new CA EMSC regulations. o Develop broad-based support for improving EMSC o The receiving hospitals are required to have pediatric emergency care GOALS- Disaster coordinator (PECCs) with competency; pediatric quality improvement, policies, To most efficiently and effectively help one of the most vulnerable o ulations Burin times of disaster, our Page 39 R C E y ~ r E °' N m N Ro d N ~~ ~ Q ~ ~ ~ d ~ ~ ~ ~ Progress - 2018 Objective - 2018-79 ~ N W ~ N '~ ai ~ a~ p~ $ p ~' UPDATED 9118119 ~ ~ ~ y aTi o 0 J E and equipment; and injury prevention, and surge preparedness plans.. goals is to organize a scalable structure for a surge Assessing PedRC designations and facilitating hospital PedRC agreements. response for children by creating an operational area EMSC PARTNERS AND COMMITTEES Pediatric Medical Surge Plan and HCC Pediatric Response Plan (Short Range/Long Range). • Representation /participation at the State designated EMS for Children Technical Advisory Committee and EMSA/CDPH Pediatric Medical Surge Project in 2018-19 ~pT RISK" BOYS AND MEN OF COLOR (BMOC) OBJECTIVES: full-time program aimed to change the • Joined the 5 state -Western Regional Alliance for Pediatric Emergency Management (WRAP-EM) to strengthen pediatric emergency preparedness. Supporting UCSF trajectory of BMOC and create career opportunity for Benioff Children's Hospital grant submission; pending award and project role. participants in EMS, public safety, and/or medical/healthcare • Representation !participation in the Alameda Countv Disaster Preparedness Health EMS Corps is a completely in-house program that Coalition for integration of pediatric medical surge and the Receiving Hospital provides life coaching, mentoring, case management, Committee for EMSC initiatives. counseling and EMT training to create opportunity for • Partnering with Contra Costa County NICU Planning group with focus on promoting careers in healthcare and public safety to young men of the Triage, Resource Allocation for In-patient (Neonates) - "TRAIN" Model color and change their lives' statistical trajectory CONFERENCES AND TRAINING —PEDIATRIC FOCUS Facilitate EMT training portion of EMS Corps program • Promoting integration of pediatric content in State and National Conferences on with emphasis on preparedness for a realistic EMS Provide pediatric surge presentation for the HCC — ALCO Disaster Preparedness workplace environment Health Coalition (DPHC) o Improve pass rates for National Registry Exam, • EMSC Coordinator attended CA EMSA/CDPH EPO Conference in Sacramento June o Improve follow-up with alumni 2019 and CHA Conference in Pasadena September 2019; presented poster: "Local o Increase working with community partners Pediatric Readiness and Surge CONOPs in Action" • Pediatric Surge planning presentation for: ALCO DPHC Medical Surge Week o Improve communication Webinars July 2019; and SWMHE Tabletop Exercise 2018 and 2019. —"---------------- • Partnering with Contra Costa NICU Planning group -Attended joint Kaiser Santa EMS CORP Rosa presentation AAR post 2017 Firestorms in 2018 Promote continuation of the program including PEDIATRICS -PLANS AND POLICIES (DISASTER /SURGE) development of staff to practice the same delivery model • Developed Pediatric Receiving Center (PedRC) policies and agreements for all of curriculum hospitals. Specific policies developed for Comprehensive, Advance, and General o Develop alumni to regularly assist in mentoring and PedRCs. • Children's Disaster CONOPs (Annex to operational Area EOP) submitted to OES EMT training Operations Council for submission to Alameda County Board. The proposed annex o Develop EMT refresher and skills classes to be will be updated. The EMSC Coordinator contributed to original version and will be available for a nominal fee participating on the committee to finalize the plan. o Develop program to include young women of color • EMSC Coordinator supporting planning committee for State Pediatric Medical Surge OLDER POPULATIONS (65+) Planning — to develop Patient Movement Plan —Pediatric Surge Annex OBJECTIVES: Continue implementation of PIC evidence • Developed CA Children's Disaster CONOPs draft framework shared at state EPO based "Matter of Balance" by training/monitoring coaches and and national health care coalition conferences... Alameda County EMS website updated with pediatric medical surge planning conducting 14, 8-week 2 hour classes Stand-up Matter of information and links for system-wide partners Balance (MOB) -Workshops throughout the County with • Updated EMS Pediatric Medical Surge Plan 2018 and EMS Surge Plan 2019 effort to offer workshops for underserved and non-English s~~~M_______~_ speaking older adults. Deliverables include enhancing the °AT RISK" BOYS AND MEN OF COLOR (BMOC prehospital use of STEADI (Stop Elderly Accidents, Death, PROGRESS: and Injury) to assess fall risk of certain EMS patients and • EMS Corps training and peer support mentoring provided in 2015-19 (on-going). referring them to designated organization for further EMT TRAINING -PROVIDED BY EMS FOR EMS CORPS assessment and referral. this evidence-based program • EMS Prehospital Care Coordinators continued support EMT training component of 2018 and 2019 Annual SIPP Forum —Plan for 2020 the EMS Corps cohort Continue to offer training and life coach support to provide forum men of color a career path in EMS. Matter of Balance is an evidence-based fall prevention EMS Corps: Career and Workforce Development program designed to reduce elderly falls and the fear of Page 40 3 _ "' dl ~ N ~ .. E d y C —'' y `m z >. R Q ~ a~i 'cE R o R~-~ ~ ~ ~ ~, ~ ~ p~ ~ Progress - 2018 Objective - 2018-19 ~g W z '~ ~ ~ a~ p~ ~ UPDATED 9118!19 y ~ ~ ~ y a~ o j d 0 ~ • Cohort 14 ended on January 3, 2019. Cohort 14 had a 100% final passage rate falling by cognitive restructuring and exercise. STEADI • 14 students have passed the NREMT. One alumna is employed at Royal Ambulance is a fall risk assessment tool developed by the CDC to • Outreach eight events with partnering programs, approximately 400 students identify level of fall risk of individuals. Both programs • Taught four CPR Classes to partnering programs have been implemented in the County in an effort to • Applications for cohort 15 have ended and classes started on February 8, 2019. reduce elderly falls and mitigate related injuries. • Partnership with San Mateo County sponsoring three students for cohort 15. ---------------------------- -INTELLECTUAL AND DEVELOPMENTAL • Cohort 15 classes started on February 8, 2019 with a current midterm passing rate DISABLED POPULATION (IDD) of 100%. Continued success with post-program employment and working to OBJECTIVES: multidisciplinary team working in collaboration establish a definitive employment pipeline providing conditional employment offers to promote training, navigation and policy for those in crisis prior to program completion. identified as having IDD. Crisis includes medical and • Engaging EMS Corps cohort to volunteer with community education /training events behavioral emergencies. • On-going development of plan for first gender non-specific cohort. SHORT RANGE: EMS CORP AND HEALTH PATHWAY PARTNERSHIP • Develop mission statement, identify community partners, investigate training models for first responders and • Assignments - Refer to EMS Organization Chart Table 2b 2018 Plan Update others who would interact with this population during CAREER AND WORKFORCE DEVELOPMENT crisis 2018 4"' Quarter LONG RANGE: Alameda County Health Pathway Partners (ACHPP): Secure funding and promote policy for sustainability • Planed Allied Health Expo for April 10th. 2019 at San Leandro Adult School ppT1ENTS WITH MENTAL HEALTH ISSUES • Presented at the Jobs for the Future Workforce Conference in November 2018 OBJECTIVES: • Awarded 7 Mini Grants to Health Pathway Partners with BYA • Hosted ACHPP 6th Annual IAC Convening Meeting Collaborate with local Iaw enforcement (LE) agencies • Hosted end of the year partners' gathering and Behavioral Health Care Services (BHCS) to • Collected aggregate data from partners navigate those with mental health issues in crisis to • Enrolled in Salesforce Nonprofit Starters Pack appropriate care and services Health Coach: SHORT-RANGE PLAN: • Finished conducting all calls for IRB Health Coach Study Foster productive cof~aborative relationships with law • Kaiser Community Benefits Grant Board letter approved enforcement and County Behavioral Health Care • Updating all contents of Health Coach Materials Services, promote and implement multidisciplinary • Hired Health Coach Program Manager/Trainer training and transportation program. • Submitted Kaiser Mid-Year Report Beta Test the CATT Project • Submitted grant application for Stroke Shields Foundation LONG-RANGE PLAN: Cherry Hill: Develo P policy and procedure to navigate those with Oriented new director of Cherry Hill to Medical Triage mental health issues in crisis to appropriate transport, • Started Medi-CAL provider application • Triage provided for over 200 clients care, and services _____________________________ FREQUENT 911/EMERGENCY USERS • Obtained additional funding and support for Health Coach program and expansion of WHOLE PERSON CARE PROJECT EMS Corps to non-gender specific in July 2018 Objectives: • Broad- based collaboration in conjunction with the INTELLECTUAL AND DEVELOPMENTAL DISABLED POPULATION County Health Care Services Agency and other service PROGRESS -Mission statement developed: IDDFT is an inclusive and collaborative providers to develop novel approaches to integrating team assembled to improve services for individuals with intellectually &developmentally medical, health, mental health, and social services for disabilities who require forensic support in the East Bay high utilizers • Worked with Intellectual and Developmental Disability Forensic Team (IDDFT) to SHORT RANGE PLAN: develop goals for 2018 using Sequential Intercept technique Establish data sharing capability and leverage relative to Health Information Exchange efforts. Partner to identify Page 41 C ~ ~ ~ ~ O N d ~ ~ m ~ ~ ~ Progress — 2018 Objective — 2018-19 R W ~ •g m ~ a> p~ $ UPDATED 9/18/19 N ~ ~ ~ y a~ j 0 E v • Three meetings conducted with representation from the Development Disabilities novel approaches to care for high utilizers of multiple Council (DDC), board and care homes, subject matter experts with professional systems as well as 5150 population —reduce experience dealing with this population, and parents dependence of these populations on EMS • Curriculum development for first responder (LE, Fire, EMS) training in progress LONG-RANGE PLAN: • Applied for grant through Autism Speaks to fund autism awareness training Investigate options for sustainability PATIENTS WITH MENTAL HEALTH ISSUES -- '- --' '— '—'— PROGRESS: "AT RISK POPULATIONS" —Policies and Training • Member of Alameda County Multi-Discipline Forensic Team (MDF~ in 2016 to OBJECTIVES: present. Attended MDFT meetings- networking with local Law Enforcement, Integrate policies, procedures, and training to include "At Behavioral health Care Services (BRCS), probation, district attorney, veterans Risk" functional needs populations. Collaborate with organizations that serve "At Risk" populations to programs, behavioral health advocates, multiple community based organizations leverage effective solutions and ensure "inclusive" • Provided reports for transported patients on 5150 holds to various stakeholders planning. • Worked with John George Partners and Telecare for specific high utilizer — SHORT-RANGE PLAN: emergency services utilization reduced considerably • Maintain established partnerships/collaborations and FREQUENT 911/EMERGENCY USERS program/activities PROGRESS: DOMESTIC VIOLENCE (D~ POLICY • Refer to EMS Website: http://ems.acaov.ora/ems-ALAMEDA COUNTY CARE CONNECT (WHOLE PERSON CARE) - assets/dots/Documents-BEHAVIORAL HEALTH PARTNERSHIP Forms/ALCO FM 2019%20FINAL.~df—p.3 • Continued work with community partners to develop planning to connect high SHORT RANGE: utilizers of 911 and other medical services with appropriate care (AC3) Improve EMS awareness of DV and impact on 2078 Quarter 4 community health Evaluate and adjust procedures for telephone referrals Alameda County Care Connect ole Person Care ~ 1 with Family Violence Law Center (FVLC) • Karl Sporer, MD participated in AC3 Steering Committee and Clinical Working Group Improve EMS provider documentation related to DV • Data Sharing from EMS to AC3 - Completed a list of data elements Improve data collection related to DV • Completed the technical aspects of data delivery LONG RANGE: • Participated in the initial Universal Authorization Work Group meeting Increase EMS identification of DV victims (through data collection) Mental Health First Responder • Increase referrals from the field to DV services (through —"~'~~~'~'—'~'—'—' data collection) Mental Health First Responder —Pilot Project Receive regular, appropriate feedback from FVLC Community Assessment and Transport Team (GATT) related to referrals • Developing a pilot program with Behavioral Health Care Services that will provide a • Decrease incidents of death and disability from DV Mental Health Clinician and an EMT in an unmarked vehicle to assist in timely assessment and transport to alternate destinations • One time funds from Measure A obtained. Innovation Grant for Behavioral Health submitted to the Mental Health Services Oversight and Accountability Commission (MHSOAC). Presentation made to local Mental Health Oversight Committee • Presentation made to the Board of Supervisors, Health Committee • Vehicle Purchases; Working on specifications; MOU in preparation • 2019 continued developing a pilot program with Behavioral Health Care Services and the contracted private 9-1-1 ambulance transport provider that will provide a Mental Health Clinician and an EMT in an unmarked vehicle to assist in timely assessment and transport to alternate destinations. • Procurement of program manager through hiring of EMS Coordinator with both EMS and Behavioral Health experience. Page 42 C ~~ ~ d N m l0 R Q~ m~ d R~ ~ C T~ ~ ~ e m ` ~ ._ ~ _ oC m ~o Progress — 2018 UPDATED 9/18/19 Objective — 2018-19 ~p W > > m~ ~ a> p~ $ N ~ ~ y y v p ~' 0 J E • Testing ReddiNet — HAVBed module to identify available receiving site beds for 5150 destinations. ASSE5S AND REFER • Provides alternative for selected 911 patients who have been evaluated by a paramedic. Training completed. QI monitoring of its use. Initiating discussion to include HCC clinic partners. LAW ENFORCEMENT-NARCAN • Law enforcement approved programs to provide naloxone (narcan) for suspected opiate overdoses: Alameda County Sherriffs Office; Alameda City PD; Berkeley PD; UC Berkeley PD; Emeryville PD; Livermore PD; Oakland Housing Authority; San Leandro PD; East Bay Parks Police Department; Fremont Police Department; Hayward Police Department; Newark Police Department; Oakland Police Department; Pleasanton Police Department; and Union City Police Department • Worked with Intellectual and Developmental Disability Forensic Team (IDDFTI to develop goals for 2018 using Sequential Intercept technique HEART SCREENING • Twice in the past three years, Alameda County EMS has partnered with the Via Heart Project (Non-for profit) as a Co-sponsor for a one day heart screening for children 12-25 years of age. This service is FREE of charge to the community as main sponsorship is secured by Via prior to event. The Heart Screening experience includes: Medical history, patient and family; Height, weight and blood pressure; CPR and AED training; 12-lead ECG and ECHO; Face-to-Face Physician consult 911 CLINICAL FIELD PROTOCOL REVISION 2019 • Updated Field Manuals. The Amp was updated. • Training was completed throughout the system 2019 SUMMARY OF FIELD MANUAL POLICY UPDATE — Refer to 2019 QI Plan • Refer to EMS Website: htta://ems.acgov.orq/Documents/Documents.oage? ADMINISTRATIVE • AMBULANCE REROUTING CRITERIA —BYPASS REMOVED GENERAL SECTION • ASSAULT/ABUSE/DV — p. 4-5 -Pending California Legislation • HYPERKALEMIA — p. 14 —Clarifies Hyperkalemia treatments and cautions • SCOPE OF PRACTICE — p. 20 • Pediatric Intubation removed per EMSA Olanzepine is an e~cacious and well tolerated anti-psychotic n IFT BLS Vetting in progress • TRAUMA ARREST PROTOCOL • TRAUMA PATIENT CRITERIA — p. 27 • TXA — p. 28 -California Prehospital Antifibrinolytic Therapy (Cal-PAT) Study — o "Improved mortality;" "Mortality difference was greatest in severely injured patients." "Significant reduction in total blood transfusion" ADULT /PEDIATRIC SECTIONS • ANAPHYLAXIS ADULT - p. 36 — Clarifies BLS administration of Epinephrine in Anaphylaxis • ANAPHYLAXIS PEDIATRIC . 63 Page 43 d ~ d ~ ~ p~ ~ Progress — 2018 Objective — 2018-19 ~ W 7 ~ = m ~+ u~ ~ p~ r,_, UPDATED 9/18119 H ~ m p ~' • ASYSTOLE/PEA ADULT p. 37 n "Epinephrine may improve ROSC, but it does not improve survival to discharge or neurologic outcome. Timing of epinephrine may affect patient outcome, but BLS measures are the most important aspect of resuscitation and patient survival. Time to vasopressor administration is significantly associated with ROSC, and the odds of ROSC declines by 4%for every 1-minute delay between call receipt and vasopressor administration. " • VFNT ADULT p. 59 • VF/VT PEDIATRIC p. 73 • AIRWAY OBSTRUCTION p. 62 n Pediatric Intubation (< 40 kg) removed per California EMSA • NEONATE RESUS p. 67 • POISONING p.71 • RESPIRATORY DISTRESS v. 75-76 • ROUTINE MEDICAL CARE p. 77 • MEDICATIONS p. 41 OPERATIONS SECTION • BLS/ALS FIRST RESPONDER D. 87 n Clarifies First Responder Personnel • DEATH IN THE FIELD a. 88 -Trauma Arrest Policy Pending • EQUIPMENT p. 98-104 -Clarifies equipment specifications associated with 2019 field policy updates • IFT ~. 106 • ADD OLANZAPINE (NEWT —Move to Procedures Section • "Olanzapine is an e~cacious and well-tolerated atypical antipsychotic indicated for the treatment of schizophrenia and acute manic or mixed episodes, along with maintenance therapy in bipolar disorder and (in some countries) related psychiatric disorders. n Consistent with findings from large comparative clinical teals and observational studies, olanzapine has been found to be comparable or superior to other atypical antipsychotic medications in meta-analyses of head-to-head studies using a variety of efficacy /effectiveness and safety/tolerability outcomes. • EXCITED DELIRIUM • Excited Delirium algorithm pathway converges links to applicable existing field manual treatment policies. • PSYCHIATRIC AND BEHAVIORAL EMERGENCIES P. 112 • RESPONDING UNITS—CancelinglReducinq Code a. 114 • UNUSUAL OCCURRENCE -Identifies improvement opportunities in clinical outcomes and/or system structures /processes. PROCEDURES • ADVANCED AIRWAY o. 116 CHILD INJURY PREVENTION • Alameda County EMS is expanding community outreach to reduce number of childhood injuries SAFE KIDS COALITION • Refer To EMS Website: http://ems.acaov.or4/CommNResources/CIP.paae? • Active and meets monthly; partnered on implementation of the following community based events: Safe Kids Day—booster seat distribution; numerous health fairs— helmet fittin s/distribution; communi based care seat check-u events; and Page 44 3w ~,~ m R Q ~ ~ ~ R = T~ g i ~ d ~ ~ ~ ~ Progress — 2018 Objective — 2018-19 R W = ~ ~ a~ p~ ~ UPDATED 9118/19 H ~ ~ ~ y a~ J m 0 ~ v E monthly car seat (check-up) inspection station; facilitated Worids' Largest Swimming Lesson; established Memoranda of Understanding with 12 local community based groups to promote community based child passenger safety education and car seat check-up events. CHILD PASSENGER SAFETY 2018- Conducted 19 Child Passenger Safety Check-Up Events/Inspection Stations • Provided education to 923 individuals • Distributed 413 child safety seats to low-income families • Provided installation assistance for 512 seats • Provided MOU holding partners with an additional 273 car seats to distribute to clients 2019 • Provided education to 366 individuals • Distributed 70 child safety seats to low-income families • Provided installation assistance for 130 seats SAFE KIDS DAY 2018 -Held 5"' annual Safe Kids Day in partnership with AEG, Oracle Arena, and AAA Distributed and properly installed 254 booster seats • Distributed and properly fit 431 wheeled sports helmets • Hosted community safety fair with 53 agencies/activities participating • 710 attendees 2019 • Held 6"' annual Safe Kids Day in partnership with University Village and AAA • Properly installed 58 car seats and distributed 31 seats • Distributed and properly fit 237 wheeled sports helmets • Hosted community safety fair with 41 agencieslactivities participating • 650-750 attendees CHILD PASSENGER SAFETY TRAININGS BASICS COURSE (CSPT1 2018 • With the support of certified instructors, IPP hosted and facilitated Child Passenger Safety Technician (CPST) classes in May, August and October 2018. Facilitated / hosted two Continuing Education Classes in August and October 2018. • Hosted 1 Basic CPS Training for RNs in June 2018 2019 • With the support of certified instructors, IPP hosted and facilitated Child Passenger Safety Technician classes in March, April and August of 2019. • Hosted 1 Basic CPS Training for RNs in July of 2019 • Hosted 1 CPST Continuing Education Classes in August of 2019 COMMUNITY EVENTS FOR CHILDREN 2018 • Distributed an additional 456 helmets at community events • Distributed a total of 6,665 pieces of safety equipment and education at various community events 2019 • Distributed an additional 303 helmets at community events • Distributed a total of 6,941 pieces of safety equipment and education at various community events EMS WEEK • Hosted EMS Week Kids Day, Mav 24, 2018 and Mav 23, 2019. Page 45 9 C m ~ r ~ m ~ ~ C — m fCOI d R Q~ 'e E R p ~ T ~ ~ ~ ~ m ~ ~ oG ~ Progress — 2018 UPDATED 9/18/19 Objective — 2018-19 {p W 3 ~ m ~' a> pl ~ N ~ ~ ~ y ~ j 0 E v • Education and activities provided over a wide variety of topics, i.e. earthquake preparedness/safety, water safety, wheeled sports safety, fire prevention, etc. SWIM SAFETY EVENT • June 21, 2018- hosted World's Largest Swimming Lesson event at Mills College Aquatic Facility. Provided 40 youth with free swim and CPR lessons. WALK TO SCHOOL DAY • 2018 -Hosted International Walk to School Day event- 325 participants in 2018 • 2019- Provided 7 presentations to professional and parent groups, educating 129 individuals in 2019 OLDER POPULATIONS (65+) - PROGRESS: SENIOR INJURY PREVENTION PROGRAM (SIPP) • Refer to EMS Website: http://ems.acgov.orp/CommtvResources/SIPP.oage? SENIORS • 2017-SIPP was awarded a 3 year grant from the Partners in Care Foundation to implement several fall prevention programs. The grant is now in its third year cycle. • SIPP will provide incentives to some of its members to help celebrate Fall Prevention Awareness Week, September 15-21 2019. • SIPP is helping plan and will participate in the Healthy Living Festival at the Oakland Zoo on September 19. 2018-19 • In its 19"' year, the 2019 forum was held 4-18-19. The theme of the Forum was "The Art of Aging". 141 people attended the day-long event. • The 2018 event took place in Oakland in May 2018 with 140 participants. • Completed year 2 initiated year 3 of Partners in Care (PIC) Matter of Balance (MOB) grant, a falls and prevention program. • Year 1—successfully fulfill terms of grant by training 30 coaches (trainers), completed 64 2-hour sessions. • Year 2—trained 15 coaches and one master trainer; initiated 8 week, 2-hour workshops with 21 workshops county-wide resulting in 235 participants and 198 completers. o Beginning Year 3 currently • Initiated implementation of STEADI (Stop Elderly Accidents, Death and Injury) a risk assessment tool by developing protocols for EMTs and developed referral mechanism with six organizations for clients at risk for falling. 0 5 senior services partners identified to take referrals based on STEADI assessments done in the 911 system o Produced online training for field personnel to perform STEADI assessments 0 2018- Attended 4 health fairs reaching 516 individuals 0 2019- Attended 3 health fairs reaching 239 individuals 0 2018- Distributed 2,551 pieces of safety education &equipment to older adults • 2019- Distributed 1,269 pieces of safety education and equipment to older adults SENIOR INJURY PREVENTION PROJECT • Alameda County EMS is reducing the number of preventable injuries to older adults in Alameda County through medication management subcontracts with the communit based or anizations listed below. Funded b Measure A, the Page 46 ~ y ~.., d N ~~ d i`o R a~ ~ E R o ~ T _ ~ ;! ~ ~ ~ p~ ~ Progress — 2018 Objective — 2018-19 tE W ~ '= y~ t' a> p1 ~ UPDATED 9/18/19 H ~ ~ ~ ~ s u~ N o p w J ~ organizations listed below effectively conduct client screening, education, pharmaceutical review of medications, consultations with physicians, to increase client medication compliance and facilitate proper disposal of expired/unused medication. • Afghan Health Promoter Project -City of Fremont —Service • DaV Break Adult Centers —improved medication compliance n Senior Support Tri Valley—improved medication compliance n St. Mary's Center —Medication Safety Pilot July 15 —June 2016 • United Seniors of Oakland /Alameda -Medication Safety Program (Measure A) INJURY PREVENTON ACTIVITIES • Facilitate, Lead, and participate in the following courses and conferences to ensure needs of s ecial o ulations are addressed: NATIONAL CPS Location: CERTIFICATION COURSE • Alameda County EMS, San Leandro, CA x2 • San Joaquin County Public Health Department, Stockton, CA x2 • O. Club, Alameda. CA Alameda City Hall West, Alameda, CA #s TrainedlDates: • 3-61379/18; • 5--8/5-11/18 10-9/10-12/18 • 3-11/3-14, 2019 4-8/4-12. 2019 • 8-3/8-17, 2019 RN CPS AWARENESS Location: Alameda County EMS, San Leandro, CA CLASS AND Alameda County EMS. San Leandro CA Date: 6-28-18 and 7-18-19 # of Partici ants: 13 and 12 USOAC ANNUAL Locations: CONVENTION Eden United Church of Christ, Hayward, Oakland Date: 5/25!18 2018, # of Participants: 115 MATTER OF BALANCE 2018- 21 workshops resulting in 235 participants and 298 completers • 2019- 11 workshops resulting in 121 participants and 96 com leters to date A MATTER OF BALANCE Location: Alameda County EMS, San Leandro, CA FALL PREVENTION Date: 1/19/18-- COACN UPDATE CLASS # of Participants: 17 A MATTER OF BALANCE Location: Alameda County EMS, San Leandro, CA COACH TRAINING Date: 5/17-18/18 and 2-21/2-22, 2019 # of Partici ants: 10 & 6 MATTER OF BALANCE Location: Alameda County EMS, San Leandro, CA MASTER TRAINER Date: 1/22-23/18 # of Participants: 15 TRAINING CALIFORNIA SENIOR Location: Waterfront Hotel and Greek Orthodox Cathedral, INJURY PREVENTION Oakland EDUCATIONAL FORUM Date: 3/16118 and 4-18-19 # of Partici ants: 140 and 129 SAFE KIDS WORLDWIDE Location: Washington, D.C. CONFERENCE Date: 7-26/28-19 PRESENTATIONS Presentations to older adults on falls prevention, emergency re aredness, and Drive Smart Page 47 9 ~ d H ~ r E d d N L~ d N C► N z ~ ~ ~ i ~ ~ ~ ~ Progress - 2018 Objective - 2018-19 R W ~ ~' a> p~ ~ UPDATED 9/18119 N ~ a+~ ~ y u~ o j ~ 0 ~ 2018- 19 presentations 2018- 433 people reached 2019- 12 presentations 2019- 272 eo le reached 1.11 System 3 3 3 PROGRESS TO DATE: Each local EMS agency shall identify the optimal roles and Participants HOSPITAL POLICY ISSUES: responsibilities of system participants. • EMS Agency staff continue to meet with Hospital leadership to address policy, pB,IECTIVES: LONG TERM contract and MOU issues as needed. Staff have also spearheaded significant and HOSPITAL POLICY ISSUES -OBJECTIVE: sustained improvement system-wide in ambulance patient offload time (APOT) Coordinate with Alameda County receiving hospitals —through active engagement with hospital leadership. address issues including policy issues STEMI/CARDIAC ARREST RECEIVING CENTERS ISRC/CARL) Drive ongoing reductions in APOT • Continued collection, review and analysis of performance and patient outcome data STEMIlCARDIAC ARREST CENTERS for development of new process improvement strategies as needed. ~ Enhance Survival —Cardiac Arrest Outcomes. Sustain • Completed first TWO years of official participation in the Cardiac Arrest Registry to MOUs for specialty receiving hospitals. Add bidirectional Enhance Survival (CARES) which was reflected in both 2016 and 2017 National health information exchange as well as ECMO referral CARES reports. requirement to MOUs. • Ali MOU's for specialty receiving hospitals renewed until 2020. • Kaiser Permanente Oakland went live as the seventh SRC/CARC in Alameda CONTRACTS: County January 2017, and completed first year of CARES participation that is LONG/SHORT-RANGE PLAN: reflected in the 2017 National CARES report. Stroke and STEMI/Cardiac Arrest Receiving Centers HOSPITAL MERGERS: Continued Organization Changes MOU Renewals January 2020. • UCSF Benioff Children's Hospital Oakland and Mission Bay • Incorporate NEW CA State STEMI and Stroke Critical • Stanford Health Care — ValleyCare Hospital. Care System Regulations into 2020 MOU. • Alameda Health System (Highland, Alameda, and San Leandro Hospitals). Develop STEMI and Stroke Critical Care System Plans CONTRACTS I MOUs: that reflect and comply with NEW CA State STEMI and • STEMI/CARDIAC ARREST RECEIVING CENTERS: Expires 12/2079 Stroke Regulations. (renewal 1/2020-12/2023) Renew Contracts to ensure sustainability • STROKE RECEIVING CENTERS: Expire 12/2019 (renewal 1/2020-12/2023) • TRAUMA CENTERS: Expire 6/2021 (renewal 7/2021-612024) FALCK —New 911 Contract started July 1, 2019 PARAMEDICS PLUS -Provided 911 services through June 30, 2019. Contract ended. CONTRACT EXTENSIONS — FRALS AND FIRE TRANSPORT • New ALS ambulance and first responder agreements with the cities of Alameda, Albany, Berkeley, and Piedmont were approved by the County Board of Supervisors and contracts executed providing for service through June 30, 2024, each with an option to extend for an additional five (5) year period. FIRST RESPONDER ADVANCED LIFE SUPPORT (FRALS) First Responder Advanced Life Support (FRALS) agreements executed through June 30, 2024 with an option to extend for an additional five (5) year period. (Alameda County Fire, City of Dublin; City of Emeryville; City of Fremont; City of Hayward; City of Livermore; City of Newark; City of Oakland; City of Piedmont; City of Pleasanton; City of San Leandro; and City of Union City) ALAMEDA COUNTY REGIONAL EMERGENCY COMMUNICATIONS CENTER (ACRECC) • The Emergency Medical Dispatch agreement with the Alameda County Regional Emergency Communications center provides for service through June 30, 2024 and contains options to emend thereafter. REDDINET Page 48 C d ~ Y+ ~ ~ d f6 9 R a ~ E m 'cE C R`o C >+ ls~ ~ ~ ~ ~ m ~ ~ p~ ~ Progress — 2018 Objective — 2018-19 ip W > > m ~ a~ p1 $ UPDATED 9/18/19 H ~ ~ ~ y ~ o j ~' 0 ~ • ReddiNet Communications Contract extended for 5 years through June 30, 2024 • Additional HCC partner users activated on ReddiNet. ELECTRONIC HEALTH RECORD (EHR) • EHR -Definitive Networks Incorporated Data Support /Training /Analytics Services July 2019-2021 • Implementing ESO EHR system wide • Ex anded Frist Watch data anal ics Regulatory Activities: x •12 Review & 3 3 3 (Refer to Quality Improvement Plan 2019) Each 1oca1 EMS agency shall provide for review and Monitoring PROGRESS TO DATE: monitoring of EMS system operations. • Expanding Alameda County EMS data analysis • Currently, Alameda County EMS is in developing a bi-directional data exchange with OBJECTIVES: Coordinate analysis of all patient care data Alameda County specialty centers and all Receiving Hospital EDs. The data is from "first ring" at PSAP to discharge from receiving hospital. required per the CA EMSC, STROKE, and STEMI regulations. Apply data analysis to policy changes and educational • All specialty receiving facility MOUs beginning May 2016 includes language requiring venues. participation in a bi-directional data exchange. SHORT-RANGE: Expanded pre-hospital data analysis with dashboards monitoring pertorm~nce. • Enhanced monitoring, analysis and ongoing performance improvement efforts related to ring, EMD/MPDS and dispatch times LONG-RANGE PLAN: • EMS link to Receiving Hospital data. • NEW: U dated QI Plan in 2019 1.13 Coordination 3 (No Change) Each local EMS agency shall coordinate EMS system EMS AgerScy coordinates: EMS System per Division 2.5 of the Health and Safety Code: operations. Chapter 4. EMS coordinates Quality Improvement; committees (Refer to 1.03 for OBJECTIVE: Alameda County EMS coordinating EMS committees s stem o erations 1.14 policy 8 3 3 PROGRESS TO DATE: OBJECTIVES: Develop policies and best practices based on Procedures Free online EMS Policy and Protocol a~a is available on Google and Apple app the latest best available evidence from studies, best Manual In an effort to modernize the delivery of field treatment protocols, Alameda County practices, and local data analysis. Yearly review of policy and EMS has developed a Mobile Field Manual that runs as a native application on both procedure manuals Android and iOS handsets and tablets. By digitizing the delivery of the Alameda SHORT RANGE PLAN: Continue to develop and update field County EMS field manual, Alameda County EMS is better able to disseminate minor policy manual as needed. Ensure accessible formats. corrections as needed. NEW: • Alameda County EMS Mobile Field Manual application also provides several useful Implement online field manual application drug calculators that can assist clinicians at the point of care; this is especially useful Improve administration review and update process for weight based pediatric drug dosages. Another feature that the application Ensure annual field manual update provides is a GPS enabled mapping system that can assist clinicians at the POC to make destination decisions for specialty care (STEMI, stroke, trauma, etc.) based on real-time traffic conditions. This will facilitate decision making during peak traffic hours when the closest hospital destination is not always the quickest one. • EMS policy 2020 field manual developed. Refer to 2019 QI Plan. • 2019 911 Field Manual updates implemented • 2020 911 Field Manual updates complete, Train the Trainer scheduled Sep.2019 • 2019 Critical Care Paramedic (CCP) Field Manual updates implemented • EquipmenUSupplies QI Policy implemented 2018 • Polic 2000 Polic /Skills Com etencies u date com leted 2018 Page 49 '9 R d E N ~ C c m N ~ ~ R Cf a~ ~ T _ a ~ i E ~ o oC ~ ~ ~ Progress — 2018 Objective — 2018-19 R N W ~ N 3 d ~ ~' ~ ~' UPDATED 9/18!19 ~ ~ ~ y aTi o J 0 ~ 1.15 Compliance 3 3 PROGRESS TO DATE: Each local EMS agency shall have a mechanism to review, w/Policies Development of a bidirectional exchange of data with hospitals. monitor, and enforce compliance with system policies. • Implementation of NEMSIS 3.4 -June 2017. All 911 providers submitting to OBJECTIVE: Data: Leverage HL7 compliant software systems currently in CEMSIS/NEMSIS in June 2018. place to get EMS data into hospital data systems, and • Alameda County EMS implement the CEMSIS data elements ("primary impression" get outcome data out of hospital systems and other elements) LONG RANGE PLAN. • Ensuring overarching Monitoring Mechanism: QI Committee and Plan; Policy . Continue monitoring via site visits to monitor and Review; Unusual Occurrences; Trauma Audit; Training Program and CE Provider; evaluate system components; and System Audits —Cardiac Arrest; intubation Continue 24/7 On-Call and response capabilities for INVESTIGATIONS unusual occurrences, MCIs and other immediate system Investigation of all incidents reported via the Alameda County Unusual Occurrence needs; and MCI after action reports and improvement reporting process, and coordination with all EMS providers and allied agencies to plans provide educational follow-up or disciplinary actions (where applicable). • Tracked, investigated, and managed numerous Unusual Occurrences (reallpotential reported threats to health and safety as per State regulation) reported to the EMS Agency Investigation of all alleged misconduct relative to the standards of professional licensure and attendance of administrative law hearings when appropriate ON-GOING EVALUATION 8 8 IMPROVEMENT PLANS - "REAL EVENTS" • Evaluated North Bay Butte County Firestorm 2018 Response — RDMHS providing recommendations for improvement at MHOAC Meetings and HCC Coalition meetin s. Attended Butte Count AAR. Evaluated utilization of ReddiNet olic System Finances: 1.16 Funding 3 No Change Each local EMS agency shall have a funding mechanism, Mechanism PROGRESS TO DATE: which is sufficient to ensure its continued operation and shall • 2015-16 EMS District annual report for CSA EM1983-1 including financial reports maximize use of its Emergency Medical Services Fund. completed and filed with the Board of Supervisors inclusive of recommendation / OBJECTIVE: Continue to work with appropriate entities to request for special district rate increase of 3.02% per benefit unit for 2016-17. EMS ensure long term EMS system financial sustainability system fiscal analysis completed as component of emergency ambulance services RFP process which is in progress. .edical Direction: 1.17 Medical 3 3 ~ PROGRESS TO DATE: Each local EMS agency shall plan for medical direction within Direction* Alameda County has a comprehensive plan and program for the provision of on and off- the EMS system. The plan shall identify the optimal number line medical direction within the EMS system. The plan identifies Highland Hospital as and role of base hospitals and alternative base stations and the system Base Hospital the ro/es, responsibilities, and relationships of pre-hospital • Current Base Hospital (Alameda Health System —designated since 2004. and hospital providers. • MOU with $200,000 annual subsidy completed in 2011 OBJECTIVES: • Sole Base Hospital Agreement for the County SHORT-RANGE PLAN: • Base Hospital Coordinator and Medical Director assigned. Melody Glenn MD was Update /revise Base Hospital Course for second year the Base Hospital Medical Director from July 1, 2018 to July 2019. Gene Hern MD residents in Alameda County Health Center as assumed the position of Base Hospital Medical Director upon Dr Glenn's departure. necessary All calls are recorded for QI purposes SHORT-RANGE PLAN: • Renew Base Contract -Renewed Base Hospital Contract for another three year term (2018-2021) LONG-RANGE PLAN: • Review subsid & MOU as needed 1.18 Q~Q~ ~ ~ ~ Refer to the Quality Improvement Plan 2019 Each local EMS agency shall establish a quality (No change) assurancelquality improvement (QA/QI) program. This may include use of rovidei based ro rams which area roved Page 50 3 r y ^ ~ R d E m 'c e~ ~ a R ~ Q~ ~ ~ E ~ R o ~ ~ p~ ~ Progress — 2018 Objective — 2018-19 ~p W = ~ t' d ~ p~ ~ UPDATED 9/18/19 N ~ ~ ~ai ~ a> y p ~' o ~ OTC ~ p J E Alameda County EMS ensures QI System-Wide Procedures and Plan by the local EMS agency and which are coordinated with Provider based QI Plans other system participants. OBJECTIVES: • EMS QI Plan approved by state EMSA SHORT RANGE PLAN: • CA EMSA Core Measures Continue pre-hospital data analysis and reporting from • One ePCR data collection and reporting system for all 911 providers EMS and providers utilizing Tableau analytic tool • Data analysis and trend identification LONG-RANGE PLAN Training based on trends Integration of data with hospitals via HIE and/or other • Policy Review methods • QI committee groups: EMSA Core Measures; Quality Counsel, ePCR; Equipment, NEW: STEMI/Cardiac Arrest, Stroke, Trauma Audit, and Receiving Hospital( 2018 QI Plan on Website, Updated QI plan 2019 Im rove QI communication to field from LEMSA 1 19 Policies, 3 3 PROGRESS TO DATE: OBJECTIVE: Procedures, Yearly review conducted of Clinical Protocols Sustain objective - "Provide the right resource to the Protocols EMS Medical Director participates on EMDAC Prehospital Protocol Evidence Based right patient at the right time" Reviews Prepare QI Plan 2018-19 -Improve patient outcomes EMS Operations Policies —Reviewed, Updated, and Additional Policies added: SHORT-RANGE • Ambulance Rerouting Policy (Updated 2017) Implement MPDS at Berkeley Fire Department Dispatch • Census Reporting Policy —Required for Hospital Bed Status Update Policies &Add Policies as needed: • ED Closures Policy —Required for Hospital downgrading status and/or closures Further reduce APOT and Mitigate APOD at hospitals • Emergency Re-triage and Transfers . Update Stroke &Other Policies EMS Emended Wait Times "Bvgass Policv" added in May 2015 and updated in 2017 Review and update MCI policy including MCI levels, to mitigate ambulance patient offload delays (APOD) at hospitals with increased call triage and patient tracking volumes largely due to heavy flu season, Bypass suspended January 2018. • NEW —Transfer of Care Guidelines for Hospital facilities to improve care coordination and reduce APOT. EMS Field Manual Policv 2020 Updates • Refer to ALCO 2019 EMS QI PLAN Addendum-1 • EMS Surge Plan 2019 -New Plan ~ ~20 DNR Policy 3 (No change). NEW: Improve tracking of POLST and DNR patients in ePCR PROGRESS TO DATE: im lemented in 2016 —Death in the Field Polic Z~ Determination 3 (No Change) OBJECTIVE: Annually review "Death in the Field" policy and of Death PROGRESS TO DATE: ensure effective. • Alameda County EMS has a "Death in the Field Policy" —allows for the discontinuation of a medical cardiac arrest after the persistence of anon-shockable rh hm after four rounds of dru sand/or 30 minutes of ACLS. ~.z2 Reporting of 3 (No Change) OBJECTIVES: Provide appropriate care and emotional Abuse PROGRESS TO DATE: support for patient and families. Notify the appropriate • "Reporting of Abuse" policy planning, development, and training in 2016, Alameda agencies including law enforcement, hospital staff, child and County EMS implemented in 2017 adult protective services of all suspected abuse. NEW: Develop detailed Domestic Violence Reporting Policy for 2017 1.23 Inter-facility 3 3 (No Change) OBJECTIVES: -SHORT-RANGE PLAN: Transfer PROGRESS TO DATE: Monitor Trauma Re-Triage • Pediatric Site Visits provided data on trauma re-triage. Educating all receiving hospitals on Trauma Re-triage policy. CRITICAL CARE PARAMEDIC FIELD MANUAL POLICY -UPDATES • CCP Clinical Protocol Revisions =All policies revised, written comments received. • Finalized in January 2019 meeting Page 51 C y 3 r N ~~ d N 9 y m ~ ~ m ~ _ ~ ~ `m oC R Progress - 2018 Objective - 2018-79 leg N W 7 d y '_ d ~ a~ t~ Of w p ~' UPDATED 9/18/19 d • Norepinephrine, TPA, Sodium Bicarbonate infusions added Enhanced Level: Advanced Life Support 1.24 p~S Systems 3 3 PROGRESS TO DATE: - ALS Contract Extensions Advanced life support services shall be provided only as an RFP approved part of a local EMS system and all ALS providers — shall have written agreements with the local EMS agency. • ALCO EMS completed a RFP process, to select and implement a contract for services to the Exclusive Operating Area (EOA) previously served by Paramedics OBJECTIVE: Maintain current arrangements Plus (contract ended June 30, 2019). LONG-RANGE PLAN: ALS TRANSPORT PROVIDER • Re-evaluation of EOA contract at 5 years NEW: • County's Exclusive Operating Area —New contract with Falck effective July 1, 2019 Planning to re-issue the future RFP for County EOA FRALS. FIRE AMBULANCE TRANSPORT AND MEDICAL DISPATCH emergency ground ambulance transport services before SERVICE 2024 • New ALS ambulance and first responder agreements with the cities of Alameda, Initiate planning committee to assess needs for 911 Alban Berkele and Piedmont were a y, y pproved by the County Board of Supervisors provider agency agreements and continue development and executed providing for service through June 30, 2024, each with an option to of RFP for 911 emergency ambulance services. extend for an additional five (5) year period. o EOA provider contract • The Emergency Medical Dispatch agreement with the Alameda County Regional o FRALS Contract extensions Emergency Communications center provides for service through June 30, 2024 and o Fire-based transport Contract extensions for the contains options to extend thereafter. incorporated Cities of Alameda, Albany, Berkeley FIRST RESPONDER ADVANCED LIFE SUPPORT (FRALS) and Piedmont • New FRALS agreements County-wide provide for service through June 30, 2024 with an option to extend for an additional five (5) year period. (Alameda County Fire, City of Berkeley, City of Dublin; City of Emeryville; City of Fremont; City of Hayward; City of Livermore: City of Newark; City of Oakland; City of Piedmont; City of Pleasanton; Cit of San Leandro; and Cit of Union Cit 1.25 On-Line 3 3 3 PROGRESS TO DATE: Each EMS system shall have on-line medical direction, Medical Alameda County EMS continues to have on-line medical direction provided by a Provided by a base hospital (or alternative base station) Direction base hospital — MOU contract with Alameda Health System (Highland Hospital) Physician or authorized registered nurse/mobile intensive • Continuous quality improvement process; quarterly audits of base hospital calls. care nurse. OBJECTIVE: Continuing monitoring QI and Base Hospital Refer to Quality Improvement policies and 2018 and 2019 QI Plan on the Alameda physician training County EMS Website. http://ems.acgov.orq/ems-assets/docs/Documents- SHORT-RANGE/ LONG RANGE PLAN Forms/2017-2018%20Alameda%20County%20Q1%20PIan%20Uodate.pdf QI and physician training yearly • Refer to 2019 QI Plan. Yearly Base Hospital Course for incoming second year EM residents. • More involvement of EM residents during their EMS rotation. Highland EM residents take art in a clinical case review at each Qualit Council. Enhanced Level: Trauma Care System: 1.26 Trauma 3 Refer to sections and clans: The local EMS agency shall develop a trauma care system System Plan 1.07 (Trauma Planning) Progress Update Form 2018-19 plan, based on community needs and utilization of 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 appropriate resources, which determines: optimal system design for trauma care in the EMS area, and process for • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 assigning roles to system participants, including a process • 2018-19 Trauma System Plan which allows all eligible facilities to apply. PROGRESS TO DATE: Alameda County EMS has a specific trauma care system plan, up-dated annually, that OBJECTIVE: Review and update a trauma care system plan determines optimal design and strategies for trauma care. Trauma Centers: Page 52 'i _ 41 ~ r ~ d N C ~ m fp d ~ d d OC ~ C >+ ~ ~ Progress - 2018 Ob]ective - 2018-19 ~p W ~ a~ p~ w UPDATED 9/18/19 N d °' a~i s a~i p ~' ~ ~ ~ N o J ~ Alameda Health System (Highland Hospital): Adult Level 1, Sutter —Eden Medical Center: Adult Level 2, UCSF Benioff Children's Hospital, Oakland: Pediatric Level 1 Trauma Plan Status: • Trauma System Plan accepted in 2015 with Alameda County partners • 2015 Trauma plan submitted in May 2016 and approved by EMSA in 2016 • MOU extended contracts with the 3 designated Trauma Centers with renewal 2021 Total Trauma Patient Volume for 2018 —The total number of trauma patients at each of the trauma centers is provided below: • UCSF Benioff Children's Hospital .....799 • Sutter Eden Medical Center............2595 • Alameda Health System —Highland Hospital......2953 • Total critical trauma patients transported to trauma centers in 2018...6347 The ten non-trauma centers in Alameda County receive some patients meeting Trauma Patient Criteria (CTP), as outlined in EMS Policy Trauma Triage Criteria. These facilities are directed to all 911 for emergent transfers to the closest trauma center. • Continued education and training on the Emergency Triage to Trauma Center Policy Ensure the process for re-triage of patients needing trauma care from non-trauma hospitals is executed efficiently. TRAUMA CENTERS —Master Contract Amendments July 2018-June 2021 • All contracts signed by hospital leadership and scheduled for presentation to the County Board of Supervisors for approval. Enhanced Level: Pediatric Emergency Medical and Critical Care System: ~ ~27 Pediatric 3 3 3 Refer to previous sections and plans: The local EMS agency shall develop a pediatric emergency System Plan 1.07 (Trauma Planning) Progress Update Form 2018-19 medical and critical care system plan, based on community • 1.10 (Special Populations) Progress Update Form 2018-19 needs and utilization of appropriate resources, which determines: The optimal system design for pediatric • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 emergency medical and critical care in the EMS area: and • 1.26 (Trauma System Plan) Progress Update 2018-19 the process for assigning roles to system participants, • 5.01 (Assessment of Capabilities) Progress Update Form 2017-18 including a process which allows all eligible facilities to apply. PROGRESS TO DATE: Alameda County EMS leverages pediatric experts and partners to develop a OBJECTIVE: The overall goal of the Alameda County EMS comprehensive EMSC program and work plan to include: for Children (EMSC) program is to ensure that acutely ill and PROGRAM MANAGEMENT AND COMMITTEES injured children have access to high quality, coordinated, and comprehensive emergency and critical care services LEMSA - EMSC personnel and program management appropriate for children's special needs. o EMSC Coordinator, Cynthia Frankel, is implementing the EMSC Regulations and is strengthening the EMSC system plan. SHORT-RANGE/ LONG RANGE • LEMSA -Pediatric committees and integration into existing committees Continue to assess the local EDs for pediatric capability. n Integration QI and Disaster Preparedness Health Coalition Meetings Facilitate hospital and ALS pediatric readiness with o Integration of Trauma System Plan. Refer to Trauma Plan 2018-19 focus on pediatric medical surge o EMSC, Pediatric Readiness, and Surge Advisory Meeting was held July 27, Implement CA EMSC regulations -Strengthen the 2018, January 2019, April 2019. July 26, 2019 program consistent with CA EMSC regulations • EMSC coordination and collaboration with Child Injury prevention program Continue to promote the TRAIN Model with focus on o Refer to Alameda County EMS Website NICU. o http://ems.acgov.orq/CommtvResources/PreventionPrograms.paqe? • EMSC integration in Trauma Program — Refer to Trauma System Plan 2018 • EMSC Coordinator participates on the CA EMSC-TAC Committee and Disaster Committee; CDPH/EMSA Pediatric Sure ro ect committee; and su orts ASPR Page 53 '~ C ~ ~ ~ N ~ N ~ 4) c0 R Q ~ 01 C ~ C ~+ '~ w ~ ~ ~ m ~ oC ~ Progress — 2018 ObJeetive — 201 &19 W~ ~~ o T C~ UPDATED 9/18H9 N ~ ~ ~ ~ J a ~ o E Pediatric Centers of Excellence Project Grant 2019 with Western Regional ANiance Planning Emergency Management Team POLICIES • Ensuring pediatric administrative and field policies for care and services • Refer to: http://ems.acgov.orq/ClinicalProcedures/FieldTreatmtProtocols.~a4e~ http: /lems. acpov. orq/Documents/Documents. page? o First response non-transport o Transport o Intertacility transfer o Critical care o Pediatric specific personnel training o Pediatric ambulance equipment o Data management requirements duality improvement plan and evaluation o PedRCs Policy for Hospitals. • Pediatric patient destination policies -EMS agency RESEARCH • Research Collaborations: PECARN Node and ASPR Pediatric Surge Grant — 5 State Western Alliance Grant —Lead UCSF Benioff Children's Hospital Oakland (Pending award) —Provide support and content development CLINICAL OPERATIONS TRAINING • Continuing education and training o Education on EMSC Prehosaital Policies and Procedures —New Pediatric updates for 2018-19 ASSESSMENT, TRAINING, AND QI • Conducting Hospital ED Pediatric Readiness Site Visits for "Day to Day' and Medical Surge Readiness in 2019-20. o Refer to http://ems.acgov.orq/ClinicalProcedures/EMS-C.aage? o All 13 receiving hospitals have been scheduled for site visits in 2019. Completion of the National pediatric readiness survey is required. o Anew contract with UCSF Benioff Children's Hospital to conduct ED Site visits started January-December 2019. Provides Pediatric Site Visit assessments, training, and improvement plans. (planning addendum to continue contract), o Receiving hospitals with designated pediatric POCs and PECCs continually updated. • On-going Pediatric data collection from the EMS providers &hospitals • Mapped Pediatric critical care and trauma services facilities and assets • Identified facilities providing pediatric physical rehabilitation services CONTRACTSlAGREEMENTS • Facilitating all hospitals agreements for PedRC required policies (pending signatures) to participate in the EMSC system of care. • Pediatric contracts / agreements for Trauma. Refer to trauma plan 2018-19. COMMUNICATIONS • Ensuring field pediatric communications to receiving hospitals PEDIATRIC EMERGENCY/SURGE PLANS /TRAINING • Pediatric Surge Plan and CONOPS 2018 updated. • Developing HCC Pediatric Coalition Response Plan annex. • Children's Disaster Annex to the Operational Area EOP —finalizing plan in 2019-20. • Support California Department of Public Health and Emergency Medical Services Authori on ediatric medical sure tannin ro'ect. Page 54 s _ d E y ~ E cam, d N a ~ z d m ~ >. ~ e ~ d ~ ._ ~ d ~ ~ o~C ~ ~o ~ ~ ~ Progress — 2018 Objective — 201 &19 ~p N W ~ N ~ m ~ a~ pf ~ p ~' UPDATED 9118!19 ~ ~ ~ y ~ v 0 J E • Developed CA Children's Disaster CONOPs Framework and Local Pediatric Surge CONOPs as a recommendation to EMSA/CDPH. Presentation at CHA Conference September 2019. Promotes and disseminates CA Child Care Emergency Plan & "train the trainer" power point (advisor to project) DISASTER SURGE /EVACUATION EXERCISE5 /TRAINING • Integrated pediatrics in the State Medical/Health Exercises (SWMHEs) including the November 2018 Statewide Medical Health Exercise ("Novel Virus" SWMHE) upcoming functional exercise (Flood Scenario) planned for 2019. • Integrated pediatric partners in the Coalition Surge Test held on June 27, 2018 and May 30, 2019 (simulated evacuation of UCSF Benioff Children's Hospital. • Partner with Contra Costa County on the NICU Surge Planning Workgroup. Focus on Triage Resource Allocation Inpatients (TRAIN) Model implementation. Quarterly meetings planned 2019. Participated in NICU evacuation exercises Alta Bates Summit Medical Center • Participated in Medical Surge Week 2019 —Provided pediatric surge training for the HCC Disaster Preparedness Health Coalition. WEBSITE • Promote Pediatric Resource Information via Alameda County EMS Website, National Pediatric Goo lelist Serve and ASPR Tracie Pediatric Resources.Website Enhanced Level: Exclusive Operating Areas: 128 EOA Plan 3 3 Refer to previous sections and plans: OBJECTIVE: • 1.05 (System Plan) Progress Update Form 2018-19 Continue ongoing system evaluation and RFP process • 1.12 (Review and Monitoring) Progress Update Form 2018-19 *' (LONG-RANGE) • 1.18 (QA/QI) Progress Update Form 2018-19 "' • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 • 2019 QI PLAN EOA Plan -Service Area and Service Provided by: • Alameda County Exclusive Operating Area (EOA) — Falck • City of Albany —Albany Fire Department • City of Berkeley —Berkeley Fire Department • City of Piedmont —Piedmont Fire Department • City of Alameda —Alameda City Fire Department Initiatin tannin for next Alameda Coun Exclusive O eratin Area EOA RFP. B. StaTflngRralning -Local EMS Agency: 2.01 Assessment of 3 3 3 Refer to previous sections and plans: Needs 1.12 (Review and Monitoring) Progress Update Form 2018-19 ** OBJECTIVES: 1.18 (QA/QI) Progress Update Form 2018-19 *' Use the data management system to assess provider compliance with Policy 2000 (Ongoing). • 1.27 Pediatric System Plan Progress Update Form 2018-19 *' To conduct training sessions regarding policy changes — • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 done annually following the policy review process and 2019 QI PLAN prior to the implementation of new policies. PROGRESS TO DATE: To assess paramedic current knowledge and skills Alameda County EMS continues to assess personnel and training needs. The primary competency (SHORT &LONG RANGE) mechanisms contribute to the assessment of needs: To assess pediatric resources and readiness consistent I Provider Agency QI Plan with CA EMSC regulations • Alameda County EMS QI Plan 2019 (No Change) • Unusual Occurrence Process — Quali Im rovement Administrative Polic Page 55 E y d N E E m R °' O1 >. C R _ Q ~ ~ ~ d OC ~ ~ ~ Progress — 2018 Objective — 2018-19 ~y r' W = y •~ j' a~ >' p~ ~ C UPDATED 9/18/19 N Q ~ c. ~~ Dy ~ ~ p o p '~ ~ • INVESTIGATIONS o Investigation of all incidents reported via the Alameda County Unusual Occurrence reporting process, and coordination with all EMS providers and allied agencies to provide educational follow-up or disciplinary actions (where applicable). o Tracked, investigated, and managed numerous Unusual Occurrences (real/potential reported threats to health and safety as per State regulation) reported to the EMS Agency • "Ride-Along" with transport providers • Mandatory Update policy training • Case Reviews by Medical Director • Training Needs based on data • Fulltime QIlEMS Coordinator • ED Pediatric Readiness Site Visits with assessment, training, and evaluation • Monitoring Emergency Pediatric Transport Call Volume • Mapped Med/Surge resources in hospitals (Pediatric Beds for NICU, PICU, and General Beds) • Utilizin CDPH Pediatric Sur e Work rou Ma in Data for Alameda Count 2.~2 Approval of 3 3 PROGRESS TO DATE: OBJECTIVE: Continue adding and approving CE providers Training Transition meeting held with training programs, out-going and in-coming transport To have Prehospital Training Programs assigned to an providers to plan/manage seamless transition for current paramedic interns placed in EMS Coordinator as a primary program the county. Obtain consistency in process for all training programs The Alameda County EMS agency has a mechanism to approve EMS education Quarterly meetings with all Program Directors Increased programs that require approval: site visits (SHORT-RANGE) • Paramedic • EMT • CE Provider • Public Safety First Aid (PSFA) Current Prehospital Training Programs: • 2 —Paramedic Training Programs (confirmed 2019) • 17 -EMT Training Programs (confirmed 2019) • 25 — CE Provider Programs (confirmed 2019) 4 — PSFA Trainin Pro rams - confirmed 2019 2.03 Personnel 3 ~ ~ (No Change) The local EMS agency shall have mechanisms to accredit. PROGRESS TO DATE: authorize, and certify pre-hospital medical personnel and EMS CONTINUING EDUCATION conduct certification reviews, in accordance with state • Web-based delivery with 24/7 access to CE certificate option provided by LEMSA regulations. This shall include a process for pre-hospital • Continuing to utilize Centrelearn for providing CE to all prehospital personnel in providers to identify and notify the local EMS agency of Alameda County. unusual occurrences that could impact EMS personnel PARAMEDIC PRECEPTOR PROGRAM certification. -----------------------------------------• Oversight, and regulation of paramedic preceptors EMS CONTINUING EDUCATION 0 31 approved preceptors across 3 transport providers (confirmed 2019) Objectives: Evaluate efficacy of contract with Target 0 20 preceptor renewals pending Solutions (formerly Centrelearn Solutions) in providing 0 4th Annual Paramedic Preceptor Seminar asynchronous CE to all prehospital personnel in Alameda 0 1 Paramedic Preceptor Training Workshop County 5 Intern Candidate Orientations (July &November 2018 and March, June & SHORT-RANGE PLAN: September 2019 Create and upload custom content relative to Alameda County needs --------------------------------LONG-RANGE PLAN: Page 56 ~ ~ ~ ~ ~ d 'cE N L ~ `o ~ a !`o z Q ~ ;; ~ ~ R ~ ~ ~¢~ p~ ~ Progress — 2018 Objective — 201 &19 R N W 3 N '~ ~ ~ a> p~ ~ ~ UPDATED 9/18/19 ~ ~ ~ y u~ o 0 j E BAY AREA PARAMEDIC JOURNAL CLUB — 2018 and 2019 Increase number of active users in system • Leadership attends Quarterly Meetings with field providers and guest speakers EMS PARAMEDIC PRECEPTOR PROGRAM ~~~- OBJECTIVES: • Promote quality paramedic field training and patient care through preceptor program SHORT-RANGE PLAN: • Policy development to limit preceptor approval term to 2 years (as opposed to continuous). Approved preceptors to satisfy County requirements including, but not limited to completing 8 extra hours of continuing education units in the topic of EMS Education (in addition to the regular 48 hours for paramedic re-licensure). Hold annual Preceptor Seminars that cover principles and practices of adult learning o Implement policy details, acknowledging expected confusion and delays due to policy being new standards o Ensure alignment with related Title 22 regulations o Improve communication with preceptors, providers and paramedic training programs LONG-RANGE PLAN: • Develop comprehensive standardized paramedic preceptor program that is consistent and integrated across provider agencies o Improve paramedic preceptor performance, o Improve paramedic preceptor professionalism o Improve paramedic preceptor accountability PARAMEDIC/EMT Certification -OBJECTIVE: SHORT-RANGE PLAN • Incorporate all actively accredited Paramedics into state EMSA database Dispatchers: 2.04 Dispatch 3 3 3 PROGRESS TO DATE: Public safety answering point (PSAP) operators with medical Training responsibility shall have emergency medical orientation and EMD -Alameda Count maintains two IAEMD ACE Accredited EMD Centers of Y all medical dispatch personnel (both public and private) shall Excellence. receive emergency medical dispatch training in accordance with the EMS Authority's Emergency Medical Dispatch • ACRECC (Alameda County Regional Emergency Communications Center), provides Guidelines. EMD services for all areas of the County other than the City of Oakland. ACRECC also dispatches first responder and ambulance transport apparatus for several OBJECTIVE —Continuously monitor compliance municipalities as well as Falck County-wide. LONG-RANGE • Oakland Fire Department provides EMD services for the City of Oakland. Public safety answering point (PSAPs) operators with MEDICAL DISPATCH REVIEW COMMITTEE medical dispatch responsibilities and all medical dispatch personnel are trained and tested in accordance • In an effort to coordinate and standardize emergency medical dispatch functions with the EMS Authority's Emergency Medical Dispatch throughout the County, Alameda County EMS has established a Medical Dispatch Guidelines Page 57 C j w ~ ~ d t6 R a E ~£ R o ~ _ ~ ~ ~ ~ ~ p~ ~ Progress - 2018 Objective - 201 &19 R W ~ 'C u~ pf ~ UPDATED 9/18/19 y d d m i~ O ~' ~ ~ ~ y V J ~ Review Committee that is comprised of representatives from ACRECC and the SHORT-RANGE PLAN Oakland Fire Department Dispatch center as well as field personnel, the EMS Work with both Dispatch Centers regarding education Director, EMS Medical Director and provider agency and leadership. and specific QPJQI for calls that are or could be cardiac • The establishment of this committee has assisted in standardizing the assignment of arrest and warrant Dispatch Assisted Pre-Arrival CPR EMS resources throughout the county. and AED instructions. • Establishing cross-center dialogue has improved our data collection with respect to MPDS activities. • This improved data collection has provided us the means to more accurately assess the effectiveness of our MPDS im lementation. '~st Responders (non-transporting): ~5 First 3 Refer to previous sections and plans: At least one person on each non-transporting EMS first Responder 2.06 (Response) Progress Update 2018-19 response unit shall have been trained to administer first aid Training 2.09 (CPR Training) Progress Update 2018-19 and CPR within the previous three years. • 2.12 (Early Defibrillation Progress Update 2018-19 Objective: (No Change) At least one person on each non-transporting first PROGRESS TO DATE: response unit trained in first aid and CPR every two TRAINING —POLICIES AND AGREEMENTS— Requirements years. • Refer to the Alameda County 2019 Field Manual —General Operational Policies (available on the Alameda County EMS website): • Refer to the Alameda County EMS Administrative Manual. http://ems.acgov.orq/Documents/Documents.page? • Paramedic Accreditation policy updated 2018 - Policy and Skilis Competency Requirements (# 2000) PROVIDER CONTRACTS/AGREEMENTS Refer to the EMS First Responder Advanced Life Support Services Agreements (FRALS) with Fire Departments COUNTY-WIDE AUTOMATIC EXTERNAL DEFIBRILLATORS • 2691 -Total AEDs in Alameda County_ as of August 28, 2019 Refer to the Alameda County EMS Website for AED/PAD program information http://ems.acpov. org/CommtvResources/AEDPAD.page? QUALITY IMPROVEMENT PLAN • Refer to the 2019 Qualit Im rovement Plan with trainin Pro ram Re uirements 2.06 Response 3 3 3 Refer to previous sections and plans: Public safety agencies and industrial first aid teams shall be • 2.06 (Response) Progress Update 2018-19 encouraged to respond to medical emergencies and shall be • 2.12 (Early Defibrillation Progress Update 2018-19 utilized in accordance with local EMS agency policies PROGRESS TO DATE: On-going OBJECTIVES: (LONG-RANGE) EMS POLICY MANUAL 2018 AND 2019 PAD PROGRAM • Refer to the Alameda County Administration and Policy Manual 2019 (available on Sustain the existing programs in Alameda County and the Alameda County EMS Website) expand if possible. (Refer to 2.09). • http://ems.acgov.orq/ClinicalProcedures/FieldTreatmtProtocols.page? Facilitate HeartSAFE Project (SHORT RANGEI TACTICAL MEDICINE AND URBAN SHIELD TACTICAL MEDICINE Prehospital training in accordance with EMSA /POST approved tactical medicine Provide a standards based, tactically trained EMS curriculum. Currently offering 2 Tactical Medical Technician (TMT) 40 hour classes workforce to be available to Law Enforcement on an as per year. TMT is POST, EMSA and LEMSA approved. needed basis as well as provide enhanced capability to • Urban Shield Exercise held September 8-10, 2018. Urban Shield defunded by BOS respond to violent high risk events like active shooter actions. incidents TACTICAL MEDICINE TRAINING CPR 7 Continue ro ram Refer to 2.09 Page 58 ~ E H •~ d N R~ Q~ ~ ~ ~ d R o~ ~ ~ ~ p~ ~ Progress - 2018 Objective - 2018-19 R W ~ ~ a~ pf ~ UPDATED 9/18/19 N d ~ d a~i ~~ S~ yv O `~ ~ E • ALCO EMS has become an approved National Association of EMTs training site to CO-LOCATION PROJECT provide the Tactical Emergency Casualty Care (TECC) credential. Continue to strengthen model and test in full scale SWAT CHALLENGE 2019 exercises with clinics • Coordinated with the Alameda County Sheriffs Office to include tactical medical training for EMS personnel, medical personnel and first responders in a full-scale exercise to practice response to a mass casualty active shooter event. • Training capacity: 96 medical/EMS/first responder personnel AMBULANCE STRIKE TEAMS Started and maintained the quarterly Region II RDMHS Ambulance Strike team leader course: 04/18/2018 • RDMHS Region II helped to conduct another Ambulance Strike Team Leader class as well as an EOM training session for regional stakeholders TACTICAL EMERGENCY MEDICAL SUPPORT ITEMS) TEAM • In conjunction with the County EOA Contractor, ALCO EMS has implemented and continues to develop an active Tactical Emergency Medical Support ITEMS) program including 80 hours of training .via a California EMS Authority approved curriculum and Level IIIA ballistic protection for Tactical Paramedics. • Maintained the routine operation of the ALCO TEMS team in responding to high threat /high consequence incidents county-wide. TACTICAL MEDICINE TECHNICIAN (TMT) COURSE • Medical training in accordance with EMSA/POST approved tactical medicine curriculum. Currently offering 1 Tactical Medical Technician (TM~ 40-hour class per year. TMT is POST EMSA and LEMSA approved • TECC curriculum is delivered during this course. • Course intentionally includes personnel from various agencies in the region from both private and fired-based EMS, law enforcement, and medical facilities. EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Project • Exercise Scope: Two linked exercises (Tabletop and Full Scale) tested the models for side-by-side coordinated in-the-field victim stabilization between Emergency Medical Services (EMS) units and Community Health Centers (CHC). Models were developed with coordinators from Alameda County EMS and Community Health Centers of the Alameda Health Consortium • Full-scale exercise conducted Mav 30 and 31. 2018 at three clinic locations. AED/PAD PROGRAM • As of July 10, 2018, 2691 # of Public Access Defibrillators (PAD) AEDs in Alameda County (includes HeartSAFE Project 185 AEDs) PROJECT HEARTSAFE • Alameda County EMS is continuing the HeartSAFE project at ninety three community Board of Supervisor sites for three years. The project includes maintenance of 93 AEDs at each community location. • ICE Safety Solutions is continuing to complete its 3-year contract. ICE Safety Solutions is providing AED battery and pad replacements • ALCO EMS has collaborated with Alameda County Risk Management which provides maintenance of the Project HeartSAFE AED's located in County owned and leased facilities. 2.07 Medical 3 ~ 3 PROGRESS TO DATE: Non-transporting EMS first responders shall operate under Control Refer to 1.02 and 1.24 Progress Update Form medical direction policies, as specified by the local EMS Refer to 2019 QI Plan agency medical director. Page 59 c £ ~ = y N C!N OIN R ~ Q ~ ~ ~ _ ~ ~ d R `oCC ~ ILp T ~ ~ Progress - 2078 Objective - 2018-19 R W 'C a~ pf ~ UPDATED 9/18119 N d d ~ai L~ p~ o ~ ~ ~ y ~ p J ~ ------------ OBJECTIVES: • EMS Poiicy Manual 2018 and 2019 (available on the EMS website) SHORT-RANGE PLAN: http://ems.acpov.orq/ClinicalProcedures/FieldTreatmtProtocols.page? • Ongoing Performance improvement monitoring • Annual Protocols Update Training on the Alameda County EMS website LONG-RANGE PLAN • Provider contracts and service a reements in lace Renew MOUs when appropriate Transporting Personnel: 2~0$ EMT-1 Training 3 (No change) All emergency medical transport vehicle personnel shall be PROGRESS TO DATE: All emergency medical transport vehicles have personnel currently certified at least at the EMT-1 level. OBJECTIVE certified at least at EMT-1 level. "Stang" All emergency medical transport vehicles have • Policy — Refer to Operations Policy personnel certified at least at EMT-1 level. Provider Contracts address training • EMT Certification -required training • Staffin ALS/BLS Providers re wired trainin er contract Hospital: 209 CPR Training 3 3 Refer to previous sections and plans: All allied health personnel who provide direct emergency • 2.06 (Response) Progress Update 2018-19 patient care shall be trained in CPR. • 2.12 (Early Defibrillation Progress Update 2018-19 OBJECTIVE - PROGRESS TO DATE All EMS system personnel are trained in CPR • Alameda County EMS policies require all prehospital care providers to be trained in CPR 9 -The goal is to increase the percentage of sudden CPR. cardiac arrest victims who receive effective bystander CPR CPR 9 HEARTSAFE PROJECT • State legislation requires ninth graders that take health science be trained in CPR as Facilitate CPR/AED maintenance of the 185 HeartSAFE a graduation requirement, Alameda County EMS will transition formerly used AED locations in Alameda County resources for CPR7 and will begin supporting CPR9 in a multi-year process. SHORT-RANGE PLAN • Became approved to provide AHA-equivalent (EMS Safety) CPR training, guidance Facilitate MOU implementation with HeartSAFE project and support for community CPR/AED training vendor to maintain 93 community BOS AEDs • (In 2017-18, Alameda County EMS implemented a pilot project using reusable manikins instead of individual/disposable CPR kits. Future plans will continue to support the 9th grade CPR training effort using the reusable manikins. AED/PAD PROGRAM - HEARTSAFE • ALCO EMS has collaborated with Alameda County Risk Management which funds maintenance of the Project HeartSAFE AED's located in County owned and leased facilities. • Alameda County EMS continues the HeartSAFE project at ninety three community Board of Supervisor sites for three years. The project will include maintenance of AEDs at each community location. HEART SCREENING • Twice in the past three years, Alameda County EMS has partnered with the Via Heart Project (Non-for profit) as a Co-sponsor for a one day heart screening for children 12-25 years of age. This service is FREE of charge to the community as mains onsorshi is secured b Via rior to the event. 2.10 Advanced Life 3 ~ (No Change) All emergency department physicians and registered nurses Support that provide direct emergency patient care shall be trained in PROGRESS TO DATE: No change advanced life support • The mechanism for requiring ED physicians and RNs to be trained in ALS is based OBJECTIVES: LONG-RANGE PLAN on the JCAHO requirements. EMS will continue to work collaboratively with ED Directors and managers to seek these certifications for h sicians and nurses. Page 60 ;~ ~~ d~ R Q~ ~£ R o ~ T z ~ ~ ~ ~, ~ m p~ ~ Progress - 2018 Objective - 2018-19 y W C d o a~ ~~ p~ ~ UPDATED 9/18/19 ~ ~ N 0 m o ~ ~ p J ~ Enhanced Level: Advanced Life Support 2.11 Accreditation 3 3 (No Change) The local EMS agency shall establish a procedure for Process PROGRESS TO DATE: accreditation of advanced life suppoR personnel that includes Alameda County EMS has established a procedure for accreditation of ALS personnel orientation to system policies and procedures, orientation to that includes orientation to system policies and procedures: the roles and responsibilities of providers within the local • 2018 and 2019 EMS Field Manual and Administration Policies EMS system, testing in any optional scope of practice, and Paramedic Accreditation information available on the Alameda County EMS website enrollment into the local EMS agency's quality • EMS orientation held monthly assurance/quality improvement process. • 2019 EMS Quality improvement plan OBJECTIVE: SHORT-RANGE PLAN: • Incorporate all actively accredited Paramedics (EMT-Ps) into state EMSA data base 2•~ Z Early 3 ~ ~ Refer to previous sections and plans• The local EMS agency shall establish policies for local Def brillation ~ 2.06 (Response) Progress Update 2018-19 accreditation of public safety and other basic life support personnel in early defibrillation • 2.09 (CPR Training) Progress Update 2018-19 OBJECTIVE: • 2.12 (Early Defibrillation Progress Update 2018-19 Encourage citizens to install PulsePoint on their PROGRESS TO DATE: smartphones in order to get more bystanders who are AED/PAD PROGRAM motivated to perform CPR to do so inclusive of apply • Alameda County EMS continues to support the placement of AEDs throughout defibrillators to patients in cardiac arrest Alameda County Continue HeartSAFE project • As of August 26, 2019 there are 2691 Public Access Defibrillators (PAD AEDs) in SHORT-LONG RANGE PLAN: Alameda County ~ Continue contract for HeartSAFE project to maintain 93 • The Alameda County AED locations are shared with the two 9-1-1 dispatch centers Community AEDs for three years. AED/PAD PROGRAM - HEARTSAFE PROJECT Work with Fire Departments on the data analysis • Project HeartSAFE conducted recertifications at the 185 AED site locations until regarding frequency of activations and responder July 23, 2018. After this date, 93 BOS Community AEDS monitored and maintained. participation in CPR and use of AED prior to EMS Continued contract with ICE Safety Solutions. arrival. • Alameda County EMS continues to have a designated AED Coordinator PULSEPOINT • Ongoing collaboration with Fire Departments and PulsePoint Vendor to update Alameda County AED locations Expansion of PulsePoint into the city of Oakland in progress. CERTIFICATION/RECERTIFICATION CHECKLIST • EMS Administration Manual PUBLIC SAFETY FIRST AID PROGRAMS • Implemented credentialing program as required by state regulation for Public Safety First Aid programs in 2017. Continued identifying new programs 2018-19. 2.13 Base Hospital 3 ~ ~ Refer to previous sections and plans• All base hospital/alternative base station personnel who Personnel 1.12 (Review and Monitoring) Progress Update Form 2018-19 ° provide medical direction to pre-hospital personnel shall be knowledgeable about local EMS agency policies and • 1.18 (QA/Qt) Progress Update Form 207 8-19 "' procedures and have training in radio communications • 3.01 (Communications Plan) Progress Update Form 2018-19 " techniques. • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 • 2019 QI PLAN SHORT/LONG-RANGE PLAN PROGRESS TO DATE: Performance Improvement and MOU Renewal ALAMEDA COUNTY BASE HOSPITAL -SUBSIDY MOU Page 61 '~' C E N ~ ip ~. ~ ~ ~ 'c 01 N ~ T R ~ Q~ ~ ~ ~ ~ d R p ~ m p~ ~ Progress - 2018 Objective - 2018-19 R W ~ N ~ ~ a> pf ~ UPDATED 9/18/19 N y d y~r a~ p~ ~ ~ ~ y v J E • Renewed with Base Hospital —Highland Hospital (Alameda Health System) in Oakland QUALITY IMPROVEMENT — "PATIENT CENTRIC" SYSTEM PERFORMANCE • Clinical /Operational Performance, Policy Compliance and Patient Centric Analysis - Alameda County EMS employs business intelligence software to analyze system participants' compliance with system policies. Operationally, Alameda County EMS ensures that system participants are compliant with response time and clinical re uirements C. Communications -Communications Equipment: ~~ Communication 3 r PROGRESS TO DATE: The local EMS agency shall plan for EMS communications. Plan* Refer to 2019 Communications Plan The plan shall specify the medical communications • Conducting training and exercises on all communication systems. Expanding partner capabilities of emergency medical transport vehicles, non- access to ReddiNet and other communication systems transporting advanced life support responders, and acute REDDINET COMMUNICATIONS care facilities and shall coordinate the use of frequencies with • ReddiNet access and utilization a priority; expanding to leverage new partners other users. including transport providers, clinics, skilled nursing facilities and dialysis centers. OBJECTIVE: Provide on-going training and exercises to o ReddiNet upgrades and new users for non-911 transport permitted providers. ensure redundant and interoperable communications o ReddiNet upgrades and new user for skilled nursing facilities LONG-RANGE PLAN: • Alameda County Hospitals participate in all state required HAvBed drills, Statewide . On-going training and exercises to test redundant and Medical Health Exercises (SWMHEs), and the Coalition Surge Test June 2018 and interoperable communications May 2019. . Continue to expand partner access and competency on • ReddiNet Policy tested in drills and "real events" — 2018 and 2019. ReddiNet with focus on messaging, MCI alerting, patient • ReddiNet utilized in North Bay Butte County Fires October 2019; Falck Transition tracking and customized polling July 1, 2019. SWMHE held November 2018, and Coalition Surge Test held June Behavior Health-ReddiNet training set for Sept. 15, 2019 2018 and May 2019. and Roll-out for all BH Mobile teams on Oct 1-3151, 2019. • Continue development and implementation of Pilot Community Assessment. Treatment and Transport (GATT) program in conjunction with County Behavioral Health Care Services to enhance services to individuals experiencing mental health crisis in the community and reduce prevalence of 5150 holds). Plan developed and beta test will be conducted for ReddiNet HAvBED utilization to provide availability of various possible mental health receiving facilities. • Updated ReddiNet for new primary stroke center Stanford ValleyCare hospital. 700/800 MEGAHERTZ COMMUNICATIONS EBRCS XAL COMMUNICATIONS • The EMS 700/800 Megahertz radio communications system is hosted by the East Bay Regional Communications System Authority (EBRCSA). Redundant and interoperable communications with common radio frequencies between fire and ambulance providers, hospitals and law enforcement exists. Portable EBRCSA radios have been issued to each EMS Agency Duty O~cer, the MHOAC and RDMHS Region II and have also been distributed to all hospital emergency planners for the hospital incident command centers. • 700/800 Megahertz Radio drills conducted monthly with hospital partners in 2018-19. COMMUNICATION RADIOS Redesign of EBRCS XAL Communications Code Plug to improve EMS provider radio communications NON-911 EMERGENCY PERMITTED AMBULANCE PROVIDERS • Enhanced emergency communication radio infrastructure of EMS Agency Non- Emergency Permitted Ambulance Providers to ensure compatibility with public safety and receivin hos ital radio communications s stems Page 62 ~ E N d~ d m R ~ ~ ~~ Cl N R `o R T _ Q~ ~ ~ ~ ~ ~ ~ ~ Progress - 2018 Objective - 2018-19 ~p W = •~ ~ a~ p~ ~ UPDATED 9118119 0 ~ ~ J ~ • Tracked, investigated, and managed numerous Unusual Occurrences (real/potential reported threats to health and safety as per State regulation) reported to the EMS Agency • Continued integration of EMS Agency Non-Emergency Permitted Ambulance Providers into the County disaster plan to assist large-scale movement of patients with focus on communications • Supported the deployment of Non-emergency permitted Providers to the Butte County fires, and provided assistance to all participants in acquiring County and State reimbursement for services rendered • Enhanced emergency communication radio infrastructure of EMS Agency Non- Emergency Permitted Ambulance Providers to ensure compatibility with public safety and receiving hospital radio communications systems • 100% complete with placing EBRCSA radio system in the dispatch center of each EMS Agency Non-Emergency Permitted Ambulance Providers provider. Continuing a weekly EBRICS radio test with EMS Agency Non-Emergency Permitted Ambulance Providers. Each permitted non-emergency ambulance equipped with an EBRCSA radio at end of 2018. CALIFORNIA HEALTH ALERT NETWORK (CAHAN) • Alameda County EMS has updated the CAHAN contacts with 911 and Non-911 emergency permitted Providers in 2019 • Alameda County EMS CAHAN Administrators participate in monthly CAHAN conference call meetings and exercises. LOCAL ALAMEDA COUNTY MASS NOTIFICATION SYSTEM — EVERBRIDGE • Adele Pagan (Lead) and Cynthia Frankel are the designated points of contact for the Alameda County Mass Notification System • Cynthia Frankel participating in HCSA Emergency Operations Workgroup for develop AC Alert user groups, policies, and messaging; completed additional training modules. • Adele Pagan and Cynthia Frankel participating in Mass Notification planning meeting and exercises with Alameda County OES in 2018 and 2019. ALAMEDA COUNTY EMS WEBSITE • The new website was "rolled out" July 9, 2018. The EMS Website is continually updated with the latest information to keep our partners informed and educated 3.02 Radios 3 Refer to previous sections and plans: Emergency medical transport vehicles and non-transporting • 1.12 (Review and Monitoring) Progress Update Form 2018-19 `* advanced life suppoR responders shall have two-way radio • 1.18 (QA/QI) Progress Update Form 2018-19 *' communications equipment which complies with the local EMS communications plan and which provides for dispatch • 3.01 (Communications Plan) Progress Update Form 2018-19 *' and ambulance-to-hospital communication. • 3.03 (InterFacility Transfer) Progress Update Form 2018-19 *' OBJECTIVE: • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 Distribute and test EBRICS 700/800 megahertz radios to • 2019 QI PLAN hospitals • 2019 Communications Plan PROGRESS TO DATE: Alameda County EMS has distributed EBRCSA 700/800 Megahertz radios to hospital emergency planners for use in the Hospital Command Centers. Monthly radio test with hospitals are conducted. EBRCS XAL COMMUNICATIONS • Redesign of EBRCS XAL Communications Code Plug to improve EMS provider radio communications. Page 63 ~~d N 4I (p R Q E E ~ R o R T e ~ ~ ~ d ~ ~ p~ m Progress — 2078 Objective — 2018-19 W a~ p~ rs UPDATED 9/18/19 y ~ ~ 0 J ~ ~ Rte' ~ y o ~ COMMUNICATION RADIOS -NON-EMERGENCY PERMITTED AMBULANCE PROVIDERS Enhanced emergency communication radio infrastructure of EMS Agency Non- Emergency Permitted Ambulance Providers to ensure compatibility with public safety and receivin hos ital radio communications s stems 3.03 Interfacility 3 Refer to previous sections and plans: Emergency medical transport vehicles used forinterfacility Transfer* 1.12 (Review and Monitoring) Progress Update Form 2018-19 ** transfers shall have the ability to communicate with both the • 1.18 (QAIQI) Progress Update Form 2018-19 •* sending and receiving facilities. This could be accomplished by cellular telephone • 3.01 (Communications Plan) Progress Update Form 2018-19 " • 3.02 (Radios) Progress Update Form 2018-19 *~ OBJECTIVE: Interfacility transfers via emergency transport provider shall have redundant and interoperable • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 communication to the sending and receiving facilities. 2019 QI PLAN PROGRESS TO DATE: (No change) • Transitioned to EBRCSA 700/800 Megahertz Radios • Out of county receiving facilities notified by transporting units) or the base hospital. QUALITY IMPROVEMENT EBRCS XAL COMMUNICATIONS • Redesign of EBRCS XAL Communications Code Plug to improve EMS provider radio communications. COMMUNICATION RADIOS -NON-EMERGENCY PERMITTED AMBULANCE PROVIDERS • Enhanced emergency communication radio infrastructure of EMS Agency Non- Emergency Permitted Ambulance Providers to ensure compatibility with public safety and receiving hospital radio communications systems • NON-911 PROVIDER COMMUNICATIONS: Developed and implemented plan to enhance emergency radio communications / interoperability with permitted non- emergency ambulance provider agencies. • 100% complete with placing the EBRCSA radio system in dispatch centers of the ALCO Permitted non-emergency ambulance providers • Continue a weekly EBRICS radio test with the ALCO non-emergency permitted ambulance providers • Each permitted non-emergency ambulance equipped with at least one EBRCSA radio • Non-911 Emergency Permitted ambulance provider's provide access to ReddiNet with the messaging, status, and MCI modules in 2018 and 2019. 3.04 Dispatch 3 (No change). (No change) Center PROGRESS TO DATE All emergency medical transport vehicles where physically • All EOA provider contracts require interoperable radio and disaster communications possible, (based on geography and technology), shall have capability including Falck, FRALS, and two dispatch centers -the Alameda County the ability to communicate with a single dispatch center or Regional Emergency Communications Center (ACRECC) and Oakland Fire disaster communications command post. Dispatch. OBJECTIVE: • Transport Providers have transitioned to East Bay Regional Communications All emergency medical transport vehicles will have System Authority (EBRCSA) ability to communicate with dispatch centers and • Alameda County maintains two IAED ACE Accredited EMD Centers of Excellence. disaster communications centers. OFD rovides EMD services for the Ci of Oakland. ACRECC Alameda Count Page 64 N m y ~aR dE Ea~i •~ =~ z>, Q y R o ~ ~ Progress — 2018 Objective — 2018-19 A +" W = ~ •~ ~ a~i ~` p~ ~ e UPDATED 9/18119 N Q Q ~~ O ~ m p o ~ ~ y ~ J ~ Regional Emergency Communications Center) provides EMD services for the remainder of the county. • ACRECC also dispatches first responders and ambulance apparatus for several municipalities as well as our 9-1-1 ambulance contract provider, Falck. • In an effort to coordinate and standardize emergency medical dispatch functions throughout the County, Alameda County EMS has established a Medical Dispatch Review Committee that is comprised of representatives from ACRECC and the Oakland Fire Department Dispatch center as well as field personnel, the EMS Director, EMS Medical Director and provider agency and leadership. The establishment of this committee has assisted in standardizing the assignment of EMS resources throughout the county. Establishing cross-center dialogue has improved our data collection with respect to MPDS activities. • This improved data collection has provided us the means to more accurately assess the effectiveness of our MPDS im lementation. 3.05 Hospitals 3 Refer to sections, plans, and policies: All hospitals within the local EMS system shall (where • 3.01 (Communications Plan) Progress Update Form 2018-19 '" physically possible) have the ability to communicate with • 3.02 (Radios) Progress Update Form 2018-19 ** each other by two-way radio. • ReddiNet Utilization Policy h ttp.//em s. acaov.orq/ems- assets/docs/Disaster/ACEMS Reddinet%20Utilizatfon%20Policv September%202018.pdf • 2019 Communications Plan (No change). PROGRESS TO DATE: REDDINET • ReddiNet continues to be used in Alameda County and is our dedicated emergency medical communications network. ReddiNet facilitates timely and efficient information exchange between hospitals, EMS, prehospital 911 and Non-911 Permitted Transport providers, dispatch centers, law enforcement, and other health care facilities. ReddiNet provides messaging, MCI initiation, ED status, patient tracking, and assessment polling PLANS, POLICIES, AND PROCEDURES —Hospital Communications: • Hospitals have plans, policies, and procedures that provide communication and information management protocols aligned with the Alameda County Operational Area Communications Plans • EMS Surge Plan 2019 —describes communications • Mutti-Casualty Incident Policy -describes radio utilization requirements • ReddiNet Utilization —EMS Administrative Operations Policy • Alameda County Emergency Operations Plan • Pediatric Surge Plan • Situation Status/Resource Request Forms • Alameda County Medical Health Operational Coordinator (MHOAC) Manual (pending) -identifies the notification and communication pathways. RACES /ARES • The operational area communications plan supports hospitals and includes Radio Amateur Civil Emergency Services (RACES) and Amateur Radio Emergency Services ARES Field Response Manual. On-going training opportunities offered for HCC hos ital coalition artners in 2018 and 2019. Page 65 ~ y ~° ~ 7 +N+ E m z °' ~ >. v e vQi d g = ~ ~ ~ ~ ~ ~ 16 ~ ~ A Pro ress — 2018 g Objective — 2018-19 ~p W ~ N •_ ~ a> p~ ~ UPDATED 9!18/19 N y d y r a~ p ~' ~ ~~ N v -~ E RADIOS — 700/800 MEGAHERTZ • Hospitals have received portable 700/800 Megahertz radios for their Hospital Command Centers. • A radio communications test between hos itals is conducted each month. 3.06 MCA ~ ~ ~ PROGRESS TO DATE: The local EMS agency shall review communications linkages Alameda County EMS has a MCI policy. EOP, and medical surge workplan which among providers (pre-hospital and hospital) in its jurisdiction Disasters emphasizes communications and information flow within the operational area, for their capability to provide service in the event of multi- (Consistent with the state Medical/Health EOM). casualty incidents and disasters. MEDICAL SURGE WEEK 2019 • Participated in planning and facilitating Alameda County Medical Surge Week 2019 OBJECTIVES: in coordination with Public Health Emergency Preparedness (PHEP) and Hospital LONG-RANGE Preparedness Program (HPP) partners. To ensure the ability to communicate in the event of a • Collaborated with PHEP and HPP partners to facilitate county-wide webinar to disaster with all EMS partners and stakeholders. familiarize medical partners about response and coordination related to a Utilize ReddiNet to track patients in an MCI. catastrophic event The goal is to leverage health care system partners to • Collaborated with PHEP and HPP partners to facilitate one-day workshop that ensure effective disaster preparedness and response included table-top exercise discussions, hands-on skill training, and networking communications and information management • Delivered on-site hands-on training for clinic staff at four separate agency locations building on concepts and relationships developed from 2018's Co-Location Project • Provided 2Point-of-Wounding (POV~ kits for each clinic location where training was delivered REDUNDANT AND INTEROPERABLE COMMUNICATIONS SYSTEMS • Includes 700/800 Megahertz, ReddiNet, CAHAN, Everbridge (AC Alert), Med1 (email designated for disaster response); DHV, and other systems COMMUNICATION SYSTEM TRAINING AND EXERCISES • The health care partners participated in the 2018 Statewide Medical /Health functional exercise (SWHME); 6/27/18 and 5/30/19 Coalition Surge Test. • The next SWMHE is scheduled for 11/21/19 to test communications. REDDINET TRAINING • ReddiNet training was conducted 2018-19 to practice and test MCI initiation and patient tracking. • The Alameda County EMS ReddiNet Coordinator conducts customized training for partners and tests ReddiNet in quarterly exercises including the CDPH required HAvBED drills and °real° events. REDDINET ACCESS AND UTILIZATION • Expanding "users" beyond existing partners including fire departments with hospitals, prehospital providers (911 transport and non-911 Emergency Permitted Transport Providers) OES, clinics, skilled nursing facilities and mental and behavioral health crisis service providers. Facilitating ReddiNet Upgrades with new modules and permissions for system disaster response partners in 2018-19; ensuring training and exercises for all Alameda County ReddiNet Users including FRALS, 911 transport and non- emergency Permitted Transport Providers DISASTER PREPAREDNESS HEALTH COALITION (DPHC) • Monthly steering and quarterly HCC - DPHC General Partner meetings are focused on strengthening the communications pathways and plans. RADIOS — 700/800 MEGAHERTZ Hospitals have received portable 700/800 Megahertz radios for their Hospital Command Centers. Page 66 c = ~ A ~ d `m d ~ ~ d ~ ~ ~ Progress - 2018 Objective - 2018-19 ~p W ~ y •~ ~ T p~ ~ UPDATED 9/18!19 N a m~ m ~ y p ~' o ~ ~ ~ N ~ ~ J ~ • A radio communications test between hospitals is conducted each month. CALIFORNIA HEALTH ALERT NETWORK ICAHAN) • Alameda County EMS CAHAN Administrators participate in monthly CAHAN conference call meetings and exercises. LOCAL ALAMEDA COUNTY MASS NOTIFICATION SYSTEM — EVERBRIDGE • Adele Pagan and Cynthia Frankel participating in Mass Notification planning meeting and exercises with Alameda County PH and OES in 2018 and 2019. HAM RADIO COMMUNICATIONS • Alameda County EMS collaborates with Public Health to facilitate the Alameda County disaster Preparedness Health Coalition (DPHC). Communication access and training is emphasized in the DPHC objectives. • Communication classes are offered including HAM Cram radio training and 0 ortunit to artici ate in month! HAM radio checks. Public Access: 3.07 9-1-1 Planning/ 3 3 Refer to previous sections and plans: The local EMS agency shall participate in ongoing planning Coordination 1.12 (Review and Monitoring) Progress Update Form 2018-19 ** and coordination of the 9-1-1 telephone se~viCe. • 1.18 (QA/Q1) Progress Update Form 2018-19 *' OBJECTIVE (LONG-RANGE) • 3.01 (Communications Plan) Progress Update Form 2018-19 " Work with the cities and police agencies to: • 3.04 (Dispatch Center) Progress Update Form 2018-19 ** Improve dispatcher level of training, 911 access and • 3.07 (9-1-1 Planning Coordination) Progress Update Form 2018-19 "' turn-around time for calls that need a medical response • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 Monitor dispatch times from first ring at the PSAP to on- ?019 QI PLAN scene Assist as needed with implementation of cell phone calls PROGRESS TO DATE going to local jurisdictions if the jurisdictions so choose DISPATCH SYSTEM • Alameda County maintains two IAED ACE Accredited EMD Centers of Excellence. OFD provides EMD services for the City of Oakland. ACRECC (Alameda County Regional Emergency Communications Center) provides EMD services for the remainder of the county. • The EMD Centers provide pre-arrival instructions and drive MPDS based resource assignment and response • 18 Public Safety Answering Points (PSAPs) in Alameda County receive 911 calls • ACRECC also dispatches first responders and ambulance apparatus for several municipalities as well as our 9-1-1 ambulance contract provider, Paramedics Plus. PRIMARY QUALITY IMPROVEMENT PARTNERS • All providers and dispatch centers • All PSAPS • All EOA provider contracts require radios and disaster communications including Paramedics Plus, FRALS, and the two dispatch centers (ACRECC) and Oakland Fire Dispatch. QUALITY IMPROVEMENT PLAN • Calls are reviewed for appropriateness and monitored. • In an effort to coordinate and standardize emergency medical dispatch functions throughout the County, Alameda County EMS has established a Medical Dispatch Review Committee that is comprised of representatives from ACRECC and the Oakland Fire Department Dispatch Center as well as field personnel, the EMS Director, EMS Medical Director and rovider a enc and leadershi . Page 67 = H m to m (O ~oR ~ E 3 r Ea~i '~ e°' cT c Q ~ ~ E ~ d R o ~ ~ 10 ~- p~ R Progress - 2018 Objective - 2018-19 R W 3 y '= t' d p~ ~ UPDATED 9/18/19 N y a~ m = a~ p ~ OC ~ ~ N a —~ E • The establishment of this committee has assisted in standardizing the assignment of EMS resources throughout the county. Establishing cross-center dialogue has improved our data collection with respect to MPDS activities. • This improved data collection has provided the means to more accurately assess the effectiveness of our MPDS implementation. • EMS Director and/or designee attends quarterly county-wide dispatch meetings • The planning includes EMS Dispatch QI, evaluating EBRCS Radio Communications and the review of Unusual Occurrence incidents 3.08 9-1-1 Public 3 PROGRESS TO DATE: The local EMS agency shall be involved in public education Education Through educational events especially in schools in partnership with first responder regarding the 9-1-1 telephone service as it impacts system agencies and our contracted ambulance service provider, we reach out to thousands access of school aged children each year. Some activities are provided below OBJECTIVE o Hosted EMS Week Kids Dav, 2018 (75 attendees); and 2019 (50 attendees) ~ Develop public service announcements in collaboration Education and activities provided over a wide variety of topics, i.e. earthquake nth first responder and transport provider agencies. preparedness/safety, water safety, wheeled sports safety, fire prevention, and Provide information that educates the public on why we 911 education. o Conducted a Stop the Bleed training session at the Senior Iniury Prevention use the MPDS, and how we continually monitor and Partnership Education Forum, with 100 of the 140 attendees being trained, maintain an effective deployment in the system. including Supervisor Nate Miley. Through educational conferences seniors are provided information on the 911 s stem. Select activities are listed below: SENIOR INJURY PREVENTION EDUCATIONAL FORUMS 2018: Location: Asian Cultural Center, Oakland, CA, Waterfront Hotel Date: 3/16/18 -- # of Participants: 140 2019: In its 19"' year, the 2019 forum was held 4/18/19. The theme of the Forum was "The Art of Aging". 141 people attended the day-long event. • 911 educational information updated on the EMS website: http://ems.acgov.orq/CommtvResources/EducationalResources.page? • Two enhanced EMD systems in the county utilize Medical Priority Dispatch r"^ s stem includin the Qualit Im rovement Process source Management: ~•~9 Dispatch 3 3 3 Refer to previous sections and plans: The local EMS agency shall establish guidelines for proper Triage 1.12 (Review and Monitoring) Progress Update Form 2018-19 ** dispatch triage that identifies appropriate medical response. • 1.18 (QA/QI) Progress Update Form 2018-19 ** OBJECTIVE: • 3.01 (Communications Plan) Progress Update Form 2018-19 " LONG-RANGE PLAN • 3.04 (Dispatch Center) Progress Update Form 2018-19 '* Schedule meetings for MPDS Committee and sustain • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 quality improvement plan. 2019 QI PLAN SHORT-RANGE PLAN PROGRESS TO DATE: • Work with both Dispatch Centers regarding education and specific QAIQI for calls that are or could be cardiac QUALITY IMPROVEMENT PLAN arrest and warrant Dispatch Assisted Pre-Arrival CPR • Calls are monitored and reviewed for appropriateness. and AED instructions. • In an effort to coordinate and standardize emergency medical dispatch functions throughout the County, Alameda County EMS has established a Medical Dispatch Review Committee that is comprised of representatives from ACRECC and the Oakland Fire Department Dispatch center as well as field personnel, the EMS Director, EMS Medical Director and rovider a enc and leadershi . Page 68 £ y QI vii EI f0 a E ~ °' R ~'' ~ a ~ ~ °1 ~ d ~ o ~ @ ~ ~ Progress - 2018 Objective - 2018-19 ~p W 3 _ N '~ ~' u~ pf r,, UPDATED 9/18/19 y ~ d ~ d y ~ p ~ o ~ ~ p J E • The establishment of this committee has assisted in standardizing the assignment of EMS resources throughout the county. Establishing cross-center dialogue has improved our data collection with respect to MPDS activities. • This improved data collection has provided us the means to more accurately assess and improve the effectiveness of our MPDS implementation on an ongoing basis. • ACCREC is working with Mike Jacobs, reviewing all of their cardiac arrest calls. ACRECC has changed its processes to decrease the time to CPR on these calls. DISPATCH SYSTEM AND QUALITY IMPROVEMENT • Alameda County maintains two International Academies of Emergency Dispatch (IAED) ACE Accredited Centers of Excellence. Oakland Fire Department (OFD) provides Emergency Medical Dispatch (EMD) services for the City of Oakland. ACRECC (Alameda County Regional Emergency Communications Center) provides EMD services for the remainder of the county. • The EMD Centers provide pre-arrival instructions and facilitate Medical Priority Dispatch Systems (MPDS) based prioritization. Alameda County has 18 Public Safety Answering Points (PSAPs) that receive 911 calls. 3.10 Integrated r Refer to previous sections and plans: The local EMS system shall have a functionally integrated Dispatch 3.01 (Communications Plan) Progress Update Form 2018-19 '" dispatch with system-wide emergency services coordination, • 3.04 (Dispatch Center) Progress Update Form 2018-19 *' using standardized communications frequencies. Objective: Continuously monitor mutual aid performance a 2019 QI PLAN (No change). PROGRESS TO DATE: • Alameda County EMS system has effectively transitioned to 700/800 Megahertz radios. Our system uses P25 compliant communications and participates in regional communications via the East Bay Regional Communications System. • ACRECC continues to utilize a "closest most appropriate unit' model throughout the service area to coordinate peak demand response and transport through mutual aid. • Mutual aid erformance is close) monitored and tracked for effectiveness. D. ResponselTranaportallon -Universal Level: 01 Service Area 3 3 (no change) The local EMS agency shall determine the boundaries of Boundaries* PROGRESS TO DATE: emergency medical transportation service areas. • Providing on-going monitoring for system compliance. OBJECTIVES; • ALS provider agreements with Falck, City of Albany, City of Berkeley, City of LONG- RANGE PLAN Piedmont, and City of Alameda for emergency medical transportation —Response Continuously monitor system compliance zones established as art of a reements. 4.02 Monitoring 3 Refer to previous sections and plans: The local EMS agency shall monitor emergency medical • 1.12 (Review and Monitoring) Progress Update Form 2018-19 *' transportation services to ensure compliance with appropriate • 1.18 (QAIQI) Progress Update Form 2018-19 " statutes, regulations, policies, and procedures. • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 OBJECTIVES: • 2019 QI PLAN Alameda County EMS will continue to monitor PROGRESS TO DATE: emergency medical transportation services to ensure • Standardized County-wide electronic patient care reporting and monitoring system is compliance with statutes and regulations. in place • Adherence to statutes, regulations, policies, and procedures continues to be monitored through CQI and Unusual Occurrence Processes ALS provider contracts established for emergency transport Page 69 °' N R a E E °' ~ R o R'' ~e v~ ` '~ a aC p~ ~ Progress - 2018 Objective - 2018-19 R W ~ •~ ~ a@i p~ ~ UPDATED 9/18/19 N ~ °' ~ y a~ p °10` ~ ~ J ~ QUALITY IMPROVEMENT (QI1 AND MANAGEMENT OF DATA • DATA GATHERING AND SUBMISSION o Successful conversion of EMS electronic health care record to NEMSIS 3.4, a state and national standard required for data gathering and submission. o Data ePCR Committee has been meeting monthly to make improvements in the data system. • Management of data complications created by the conversion to NEMSIS 3.4 • Completion of the first two years data with the Cardiac Arrest Registry to Enhance Survival (CARES) • Monthly QI reports -Improvements for the end user • Continued work on development and implementation of a county wide health information exchange that enables sharing of clinical data between hospitals and the prehospital system. Continue to explore integration of this work with Alameda Care Connect, a Whole Person Care pilot program. AMBULANCE PATIENT OFFLOAD TIME (APOT)- QUALITY IMPROVEMENT • Implemented developed plan to reduce ambulance patient offload times at emergency departments (time from ambulance arrival to hospital staff assuming care of patients) in conjunction with EMS provider agencies, hospitals and ACRECC • Attained and maintained notable reduction system-wide in Ambulance Patient Offload Time (APOT) with process and reporting recognized as best practice by California EMS Authority. Refer to chart below. • Refer to EMS Website: htt :l/ems.ac ov.or iAboutEMSS stern/AboutEMSS stern. a e"~ Page 70 s C d ~ w d N e°' d fo R a E Ea~i •~ E R o z~. ~a '-~ g ~ ~ ~ ~ p~ ~ Progress - 2018 Objective - 2018-19 ~ w W ~ Q. t' a~ T p~ ~ C UPDATED 9/18/19 N Q ~ .~.. p ~ a~ J o ~~ y o E NOTE' TM fONpemMN ~a ew June 2019 ~a~w M Yw~ol~ W14 elwe tlau dsne an DestlnatlonFeciliry sinaln ~~ Aw.Toc ~"'T~~~ aroo>aomn nroowary NThn O' I(aiser.WalnutCreek 2 12 min. 19.Omm. 0 O% 147 ABA4C -Berkeley Compus 9 15 mn. 77.0 mei. ~ 3 2% 19d . John George Psychi0tnc Pavilion t4 3B rm. 75.0 min. 67 20% 303 AIt3~TIBdB HOSpItUI 5 10 mn. 18.9 min. 3 1% 202 Children'sOc3kland t tame. ~83mm. o 076 9e San LeandroHospitol e ~7mn. n.Omm. 5 t% a8t Washington Hospitol a ti mn 2o.om~n. 3 ox T78 Koiser, Fremont 9 73 mn. 250min. 8 2% 449 ABMC - SUOlfitll COffIPUS ~ 14 mn. 280 min. 14 1% 9T0 Stanford Health Cnre - VolleyCare » >6m.,. 33.omn. is 3x Ste K9i56f, 091d0~id 13 21 mn. 46.0 mm. 31 5% 572 KoisBf, SEtn Le£3fldto 12 20 mn. 42.0 mm. 30 476 680 Ed6O 10 17 mn. 33.0 min. 17 2% 918 HighlpndHospital 9 16mrt 31.Omin. 17 ~% ~.t5i Stunt R056 HOSpilE11 6 16 mn. 31.0 mm. 3 tY. d27 WIIIOW ROCk C9f1tBf 3 12 mn. 19.3 mm. 0 0'"o t? • CQI DATA COLLECTION: Data update implementation and report dissemination provided as follows: o APOT Report o Change in Wall time- control chart o QI Reports =Stroke, STEMI, trauma reports and behavioral health services reports o First Watch RESPONSE TIME MONITORING: • Starting July 1, 2019, active monitoring in performance by Falck and corresponding planning/implementation of corrective procedures related to system operations. • In 2018, Alameda County EMS aggressively working to continue to improve response time performance and address issues in the system. • Clarifying expectation (hospital, field and ACRECC) regarding ambulance patient offload time (30 min or less for transfer of care to hospitals) and implementing process control measures. • Dr. Sparer (EMS Medical Director), Will McClurg (EMS Deputy Director), and Lauri McFadden (EMS Director), continue to meet with hospital executive leadership regarding this issue to ensure positive results are sustained. Alameda County EMS expects hospitals find a suitable location for patients arriving by 911 ambulance and release the crews within 30 minutes. 4.03 Classifying 3 3 Refer to previous sections and plans: The local EMS agency shall determine criteria for classifying Medical 1.12 (Review and Monitoring) Progress Update Form 2018-19 ** medical requests (e. g., emergent, urgent, and non-emergent) and shall determine the appropriate level of medical response Requests 1.18 (QA/QI) Progress Update Form 2018-19 *' to each. Page 71 R _ E ~~ _ ~ ~ d ~ ~~ R ~~ ~ ~ 'a Q ~ ~ ~ d ~ ~ p~C ~ Progress - 2018 Objective - 201 &19 !LO H W = y ~ d~ 'C a~ d Of ~ UPDATED 9/18119 ~ ~ y o J o E 3.09 (Interfacility Transfer) Progress Update Form 2018-19 OBJECTIVES: (LONG-RANGE PLAN) 2019 QI PLAN Have a fully tiered, MPDS based 9-1-1 response system PROGRESS TO DATE: that ensures the "right resources are dispatched to the • Our system continues to utilize EMD and MPDS. Alameda County EMS has been right patients at the right time(s)." using tools to analyze MPDS and clinical data to inform the decision-making process used in developing deployment strategies tied to MPDS call types and severity codes. • The Medical Dispatch Review Committee — MDRC has been formed with re resentation from all levels. ~ 04 prescheduled 3 3 PROGRESS TO DATE: Service by emergency medical transport vehicles that can be Responses Review Unusual Occurrence Reports flied as the result of a scheduled interfacility Prescheduled without negative medical impact shall be transfer provided only at levels that permit compliance with local EMS INVESTIGATIONS agency policy. o Investigation of all incidents reported via the Alameda County Unusual Occurrence OBJECTIVE: SHORT-RANGE PLAN reporting process, and coordination with ail EMS providers and allied agencies to Review Unusual Occurrence Reports filed as the result provide educational follow-up or disciplinary actions (where applicable). of a scheduled interfacility transfer o Tracked, investigated, and managed numerous Unusual Occurrences (real/potential . Review patient care data entered into the EMS system reported threats to health and safety as per State regulation) reported to the EMS data management system Agency • Reviewing patient care data entered into the EMS system data management system • EMS Policy Manual # 4605 —Critical Care Paramedics allows approved service providers to use paramedic personnel for scheduled intertacility transfer. CRITICAL CARE PARAMEDIC (CCP) • The State EMSA allows Critical Care Paramedic (CCP) inter-facility transport of patients and requires that Alameda County EMS monitor and regulate all paramedic prehospital care. The CCP Inter-facility Transport Agreement with American Medical Response incorporates County EMS guidelines and standards, patient transfer protocols, data collection and reporting requirements that ensure patient safety. There were additions to the local optional scope of practice for CCP. Alte lase TPA and Nore ine hrine 05 Response 3 ~ PROGRESS TO DATE: (No Change) Each local EMS agency shall develop response time Time* • Alameda County EMS has response time requirements to which FRALS and 911 standards for medical responses. These standards shall take ambulance transport providers must adhere. These requirements are based upon into account the total time from receipt oicall at the primary MPDS determinants in conjunction with MetrolUrban, RuraUSuburban and public safety answering point (PSAP) to anival of the Wilderness/Low Call Density Sub-Areas. responding unit at the scene, including all dispatch time • Response time compliance must be maintained at the 90 percentile level or better. intervals and driving time OBJECTIVE: (LONG-RANGE) • Continually enhance MPDS based prioritization of res onse. 4.06 Staffing 3 PROGRESS TO DATE: All emergency medical transport vehicles shall be staffed and Stang requirements are in "Staffing — ALS and BLS Providers" Policy. equipped according to current state and local EMS agency The 2018 and 2019 EMS field policies define transport provider staffing and equipment regulations and appropriately equipped for the level of service requirements: provided. • Staffing requirements OBJECTIVE: • Equipment requirements and inspection Provide the right resource to the right patient at the right • Equipment List time. Im rove the efficient use of resources 4.07 First ~ ~ PROGRESS TO DATE: As mergers and transitions occur, partners integrate into a The local EMS agency shall integrate qualified EMS first Responder cohesive response system: responder agencies (including public safety agencies and Agencies* EMS System Providers: industrial first aid teams) into the system. ALS GROUND TRANSPORT PROVIDERS rage it C y = ~. d~ m~ R a E E °' `m o R ~ ~ ;! ~ d oC ~ p~ ~ Progress — 2018 Objective — 2018-19 A W = ~ a~ p~ ~ UPDATED 9/18/19 tl~! d m m = aTi p ~' ~ ~ ~ N a J ~ • City of Alameda OBJECTIVE: • City of Aldany On-going integration of EMS first responder agencies • City of Berkeley into the system • City of Piedmont • Paramedics Plus until June 30, 2019, Contract ended. LONG-RANGE: Falck started new contract July 1, 2019 Integration of new EMS first responder agencies into the FIRST RESPONDER ALS (FRALS) system • Alameda County Fire Implement and sustain credentialing program as • City of Alameda • City of Albany required by state regulation for Public Safety First Aid • City of Berkeley programs. • City of Dublin • City of Emeryville Ciry of Fremont • City of Hayward • City of Livermore City of Newark • City of Oakland • City of Piedmont • City of Pleasanton • City of San Leandro • City of Union Ciry RECEIVING FACILITIES • Alta Bates Summit —Berkeley Campus • Alta Bates Summit —Oakland Campus • UCSF Benioff children's Hospital • Kaiser Permanente Oakland Medical Center • Alameda Hospital —Alameda Health System • Highland —Alameda Health System • San Leandro Hospital —Alameda Health System • John George Psychiatric Pavilion • Willow Rock Eden • Stanford Valley Care • Kaiser Permanente —San Leandro Hospital • Kaiser Permanente —Fremont Medical Center • Washington Hospital AIR TRANSPORT PROVIDERS • Reach • CALSTAR • LifeFlight • East Bay Regional Parks INTERFACILITY TRANSPORT PROVIDERS • Eagle Ambulance • Sutter —AMR • Royal Ambulance • NorCal Ambulance • United Ambulance • Falck Ambulance • Falcon CCT • Pro-Transport 1 • Arcadia Ambulance • Bayshore Ambulance (Business closed 4/29/2019) Ba Medic Ambulance Page 73 ;~ ~,~ m R ~~ `o T _ Q~ ~ ~ ~ d R ~ ~ {gyp ~ R Progress — 2018 Objective — 2018-19 a~ p~ y UPDATED 9/18/19 0 ~ ~ J ~ • WestMed Ambulance • Sacramento Valley Ambulance OTHER EMS SYSTEM PARTNERS • Vendors, Training Organizations (including ICE Safety Solutions, MRC, County Agencies/Departments —Board of Supervisors, schools, and others in community (Patients &their Families) PUBLIC SAFETY FIRST AID PROGRAMS —NEW PROGRAM • Implemented credentialing program as required by state regulation for Public Safety First Aid programs in 2017. HEARTSAFE PROJECT: Refer to Executive Summary • ALCO EMS has collaborated with Alameda County Risk Management which intends to fund maintenance of the Project HeartSAFE AED's located in County owned and leased facilities for the new several years. • Alameda County EMS continuing the HeartSAFE project for ninety three community Board of Supervisor sites for three years. The project will include maintenance of AEDs at each community location. 4.08 Medical & 3 (No change) The local EMS agency shall have a process for categorizing Rescue medical and rescue aircraft and shall develop policies and Aircraft* procedures regarding: • Authorization of aircraft to be utilized in pre-hospital patient care, Requesting of EMS aircraft, • Dispatching of EMS aircraft, • Determination of ems aircraft patient destination, • Orientation of pilots and medical flight crews to the local ems system, and • Addressing and resolving formal complaints regarding ems aircraft. 4.09 Air Dispatch 3 (No change) 911 Aircraft requests are initiated by either first responding or transporting The local EMS agency shall designate a dispatch center to Center agencies via ACRECC in accordance with ALCO "EMS Aircraft Transport" Field Policy. coordinate the use of air ambulances or rescue aircraR. ACRECC relays the request and coordinates the response of the appropriate Aircraft Provider. 4.10 Aircraft 3 (No change) In accordance with written agreements, CALSTAR and REACH Air Medical The local EMS agency shall identify the availability and Availability* Services cover most of the 911 EMS Aircraft transports on a rotation system in the cities staffing of medical and rescue aircraft for emergency patient of Alameda, Albany, Berkeley, Castro Valley, Emeryville, Dublin, Livermore, Oakland, transportation and shall maintain written agreements with Piedmont and San Leandro. Stanford Life Flight covers the cities of Fremont, Hayward, aeromedical services operating within the EMS area. Newark, Pleasanton, San Lorenzo, Sunol and Union City. Although infrequent, California Highway Patrol and East Bay Regional Parks when staffed with properly trained medical personnel may assist Prehospital providers in air transport. On even days, REACH is scheduled to respond to emergent 911 calls in accordance with Alameda County's "EMS Aircraft Transport" policy. On odd days, CALSTAR is scheduled to respond to emergent 911 calls. REACH ma res and on odd da s if CALSTAR is unavailable. 4.11 Specialty 3 (No change) Where applicable, the local EMS agency shall identify the Vehicles' availability and staffing ofall-terrain vehicles, snow mobiles. and water rescue and transportation vehicles. 4•~2 Disaster 3 ~ ~ PROGRESS TO DATE: Priority Projects The local EMS agency, in cooperation with the local office of Response emergency services (OES), shall plan for mobilizing response Page 74 c ~ ~ A ~ d `m9 d E aci C z >, _ ~ ~ ~ ~ ~ p~ ~ Progress — 2018 Ob'ective — 2018-19 ~ R H W ~ y 3 a~ '~ a> OI ~ ~ UPDATED 9118119 ~ d ~ g y u~i ~ o j o E ALAMEDA COUNTY EMS DISASTSER RESPONSE PLANS and transport vehicles for disaster. • EMS Surge Plan 2019 (New) completed and tested in 2019 Falck transition . NEW -Disaster Response: • Alameda County Emergency Operations Plan (pending new update 2019-20) OBJECTIVES: PEDIATRIC MEDICAL SURGE -NEW PLANS (Disaster /Surge) Continue to strengthen MHOAC program with EMS, • Pediatric Medical Surge Plan approved and tested. Public Health, and other Health Care Services Agency • Pediatric Medical Surge Plan - http://ems.acgov.orq/ems-assets/docs/Documents- partners. Priority focus —Strengthen Medical Surge Forms/alto%20ped%20med%20surge%20p1an.7.7.16.rev%20condensed.pdf Plan. EMS to continue to provide EMS Duty Officer, • HCC Pediatric Coalition Response Annex (plan to develop in 2019-20) MHOAC, RDMHS and EOC Medical/Health Branch • Alameda County EMS website updated with pediatric medical surge planning leadership response capability 24/7. information and links for system-wide partners PUBLIC ACCESS HEMORRHAGE CONTROL • Children's Disaster CONOPs Annex to operational Area EOP was temporarily on hold; continued work will occur in 2019-20 with Alameda County EMS. (PAHC) Project ALAMEDA COUNTY MHOAC MANUAL OBJECTIVES: • Alameda County EMS developing its first MHOAC Manual draft • Develop awareness campaigns, develop and deliver training, and place tourniquets with public access AEDs • The MHOAC Manual Incident Response Guides will be developed in the MHOAC in high-traffic /high-risk areas (i.e. airport, schools, Manual. The Medical Surge Plan and other annexes will be integrated as supporting shopping malls, once buildings, etc.) annexes to the MHOAC Manual Guide. SHORT RANGE PLAN: OPERATIONAL AREA EOC AND EMS BRANCH DOC Work with community media to create public awareness • ALCO EMS collaborated with the Sheriff's Department Office of Emergency Services announcements, develop training for non-medical and Homeland Security to upgrade the operational area County Emergency personnel, procure tourniquets for installation Operations Center (EOC) Medical/Health Branch with improved physical space LONG RANGE PLAN: functionality and technology assets. The EMS DOC upgrades have occurred in San Deliver train-the-trainer modules, identify partners for Leandro. EOC Medical/Health Branch will be moved to larger room for more space. sustainability CALIFORNIA MEDICAL AND PUBLIC HEALTH EOM ANNEXES CO-LOCATION PROJECT • Alameda County EMS contributed to development of the California Medical Health Co-located EMS and Primary Care Field Treatment Site EOM annexes including Behavioral Health. OBJECTIVES: • NEW Annexes to CA Medical/Health EOM shared with Alameda County HCC Disaster Preparedness Health Coalition (DPHC) Develop plan and policy to co-locate EMS at a • Facilitating integration of PH, EMS, and EH in disaster response exercises to test community-based primary care clinic to mitigate medical EOM and new annexes. surge at acute care facilities and optimize use of limited CALIFORNIA PATIENT MOVEMENT PLAN available resources after a catastrophic event • Plan completed and socialized to Region II by RDMHS. ALCO EMS participated in SHORT-RANGE PLAN: state tabletop 2017 and meetings in 2018; provided input to plan • investigate and test different models of EMS and • EMSC and HPP LEMSA Coordinator is on the planning committee for CDPH/EMSA primary care integration to discover potential issues with Pediatric Medical Surge Planning project to develop a function specific chapter to CA licensinglliability, identify primary clinic partners) Patient Movement Plan. Plan to adapt in Alameda County with focus on the pending LONG-RANGE PLAN: Pediatric Surge Coalition Annex Develop and sustain plan, exercise, and evaluate REGIONAL DISASTER MEDICAL HEALTH SPECIALIST (RDMHSI pLAMEDA COUNTY MHOAC MANUAL 8~ EMS PLANNING Plans • Aram Bronstein is the new RDMHS for Region II. • RDMHS Region II completed duties as assigned by Alameda EMS agency, SHORT TERM California EMS Authority Disaster Medical Services (EMSA DMS), and CDPH Continue to develop the MHOAC Manual Emergency Preparedness Office. Maintained normal response activities in Update EMS Surge Plan as needed accordance with the Emerqencv Operations Manual and this Scope of Work. • Initiated customization of the new Medical Health Operational Area Coordinator MHOAC Handbook Guide for Alameda Count . Partici ated in discussion Page 75 ~° °1 y E m y d R Q~ d 'c E t ~' R o ~ >. R ~-~ ~ ~ ~ d ~ ~ p~ ~ Progress - 2018 06jective - 2018-19 R W~ N 3 ~ a> p~ w UPDATED 9/18!19 N d d m i~ O~ ~ ~ ~ N o J E regarding revisions/updates of the Medical Health Operational Area Coordinator (MHOAC) Handbook in Alameda County • Hosted quarterly MHOAC Meeting in November 2018. January 2019, May, and July 2019 with normal level of attendance and participation. Continued collaboration and communications with OES regional partners Assigned by EMSA and CDPH leadership to participate in the Patient Movement Plan workgroup. Reviewed draft Patient. Movement Plan at the request of EMSA and the contractor and provided feedback as necessary. Socialized the EOM Chapters/Memos regarding Patient Movement Plan. Medical Authority. and EMSA Fee Schedules. • Worked with the contractors assigned to develop the MAC Guide, for Region II. • Continued planning for State Wide Medical Health Exercise (SWMHE) Exercise with regional stakeholders 2018-2019 • Conducted first Medical Health Operations Center Support Activities Course (MHOCSA) May 7-8, 2018 • Participated in Medical Health Operations Center Support Activities Course (MHOCSA) January, 2019. • Facilitated MHOCSA Course in Del Norte County May, 2019 • Developed and facilitated planning of MHOCSA Courses in FY 19/20 in Contra Costa and Marin Counties. • Participated in State, Regional, and Local exercises, to develop networks, and situational awareness of Regional Capabilities. • Participated in state discussion of Regional Coordination for AST/MH wraparound support during incident response. • Participated in multiple Regional/State-wide FSE, TTX, Workgroups, to progress policies/processes for planning and response. • Conducted MHOAC, RDMHS, SEMS, NIMS education courses, to familiarize stakeholders and partners with operational programs RESPONSE • Coordinated response to Camp Fire, Butte County (Region III). • Facilitated information (Flash &Situation Reports) in response to 2019 Incidents: January -Measles Outbreak in WA, February -Storms/Flooding, April —Enloe Hospital Flooding, May —Camp Ross Fire &Kern County Radioactive Exposure, June — PSPS/Red Flag Warnings &San Francisco Heat Emergency. • Coordinated AST/L Response to SF Heat Emergency. REGIONAL DISASTER MEDICAL HEALTH COORDINATOR (/RDMFIC) — PLANNING • Travis Kusman retained role of Region II RDMHC during transition to new role as EMS Administrator for San Mateo County EMS. MHOAC PROGRAM AND MHOAC COORDINATOR • On-going training on Medical/Health EOM —classes provided to Alameda County HCC Coalition DPHC partners MEDICAL SURGE PROJECTS • The priority EMS benchmark in the HPP deliverables is to strengthen medical surge capability and capacity in a disaster inclusive of children. ED PEDIATRIC READINESS PROJECT • UCSF Benioff Children's Hospital and Alameda County EMS conducts ED site visits to strengthen pediatric "day to day" and medical surge capability to care for children for Alameda County hospitals. The site visit provides customized training and a follow-u re ort with recommendations for im rovement from the UCSF Children's Page 76 e~ m~ d~ ~ e ai d ~ = ~ E ~ ~ ORC ~ oc ~ ~ ~ ~ Pro ress - 2018 9 Objective - 2018-19 ~p W = t' a> p~ ~ UPDATED 9!18/19 y Ems! m m i~ O~ ~ ~ ~ N o J ~ Hospital Oakland Site Visit Team (ED Medical Director; ED Nursing Director, and Emergency Planner). • Anew contract was negotiated with UCSF Benioff Children's Hospital Oakland and planning for addendum focused on pediatric readiness prehospital training. The EMSC, Pediatric Readiness, and Surge Advisory Meeting held quarterly (June 27, 2018. January 2019; April 26, 2019, July 26, 2019, and upcoming Oct. 25, 2019) DISASTER COMMUNICATIONS • In 2018-19, Alameda County conducted a campaign to ensure all disaster medical response organizations are competent users on ReddiNet. EBOLA /INFECTIOUS DISEASE TRANSPORTATION PROJECT • RDMHS manages the workplan for HPP Supplemental Ebola funding for EMS transport; inclusive collaboration with Region II MHOAC's; Participated in Local and Regional Ebola Capabilities training and support. • Supported and facilitated Regional Ebola training exercises. • Drafted Ebola transport ConOps, training, and collaborated with the Alameda Hospital Command Center (HCC) to purchase Ebola/ID Personal Protective Equipment and other supplies. DISASTER TEAMS AMBULANCE STRIKE TEAMS • Started and maintained the quarterly Region II RDMHS Ambulance Strike team leader course: 08/25/2016; 09/29/2016; 01/18/2017; and 04/18/2018 • RDMHS Participated in the Region II Ambulance Strike team leader course: December, 2018. TACTICAL EMERGENCY MEDICAL SUPPORT ITEMS) TEAM • Maintained the routine operation of the ALCO TEMS team in responding to high threat /high consequence incidents county-wide. • Worked with in-coming transport provider to support smooth transition of TEMS staffing and training TACTICAL MEDICAL TECHNICIAN (TMT) • Completed curriculum development for and conducted the inaugural 40 hour tactical Medical Technician (TMT) course. NON-EMERGENCY TRANSPORT SURGE TABLETOP • Conducted first annual non-emergency permitted ambulance provider system surge table top exercise. Continue developing robust plan to more smoothly integrate these providers into the emergency response network in disaster and surge situations. "REAL EVENT" DEPLOYMENTS AND SUPPORT LARGE SCALE INCIDENTS -COORDINATED PLANNING AND RESPONSE 2018 NORTHERN CA FIRESTORM -BUTTE CAMP FIRE • RDMHS and MHOAC provided mutual aid and support including EMS Coordinators serving in the Butte County PH DOC during the incident. • Alameda County EMS Branch activated to support the RDMHS needs. • RDMHS Region II worked with Butte County on response and recovery activities relating to reimbursement and environmental health impacts. Page 77 'C d E m ' c E d ~ ~ m a`6i R 'o Q E d C~ ~ ~ ~ ~ L >• ~ ~ m ~ ~ ~ oC `m ~ Progress - 2018 Objective - 2018-19 R W ~ N ~ ~ a~ p~ Y UPDATED 9118/19 N ~ m m = ~ p ~ o ~ ~ ~ N ~ p J ~ • Worked with Alameda County EMS provider agencies and PH to coordinate response to Butte and other events (i.e. regional heat-waves). WARRIORS PARADE -JUNE 2018 • EMS was involved in supporting the preparation for and coordination of medical response associated with the Warriors celebration in Oakland which was attended by in excess of a million people. EMS planned and prepared for the worst given recent terrorist activity world-wide. EMS coordinated with multiple ambulance providers, fire departments, local and federal law enforcement agencies, hospitals and EMS Agencies in neighboring counties, facilitating the delivery of highly efficient and effective emergency medical care. EXERCISES AND DRILLS STATEWIDE MEDICAL HEALTH EXERCISES (SWMHE) 2018 • The goals included testing EOC coordination, medical surge, and communications with cross sector healthcare partners. • The pediatric medical surge plan was updated and tested in the 2018 SWMHE with consideration for expansion and decompression options. • Twenty five emergency operations and command centers were activated. Over 150 participants tested their emergency plans including: County OES, EMS, BHCSA, EH, PH, and GSA; health care facilities (hospitals, clinics, and skilled nursing facilities); • The Alameda County EMS Director, RDMHS Region II, MHOAC, and EMS Coordinators participated in the Statewide Medical Health Exercise planning and event at the Emergency Operations Center (EOC), and Regional EOC. • The HPP LEMSA Coordinator was the co-project lead for the statewide exercise and HPP work plans. Prepared AAR/IP. URBAN SHIELD TRAINING AND EXERCISES • Conducted in September 2018. Final year; BOS did not approve continued training. URBAN SHIELD 2018 AND SWAT CHALLENGE 2019 • Urban Shield 2018 held and Yellow Command 9/6/18 (Scenario 96 Hours post Event Earthquake). Alameda County EOC was fully activated. • Opportunity to rotate through active shooter scenarios with medical personnel and law enforcement teams securing scenes. ACTIVE SHOOTER AND MASS VIOLENT THREAT EXERCISES - 2018 • ALCO EMS has been a leader in providing direction, planning, support and training supplies for active shooter and mass violent threat exercises throughout the county and region. In addition to several planning meeting for each jurisdiction, below are the actual dates of the all-day exercises: • Berkeley PD/ Berkeley FD, P+exercises April 19 and May 17, 2018 • Newark PD, ACFD, P+ exercises May 21 and May 24, 2018 • Livermore PD, LPFD, Reach, Cal star , P+ exercises July 16 and Aug 2, 2018 • Kaiser Permanente- OPD, P+. July 19 and July 20, 2018 • EMS Disaster and preparedness staff assisted local fire departments and law enforcement in conducting an active shooter response exercise in Livermore COALITION SURGE TEST —Hospital Evacuation Table top and Functional • The Medical Sur e pro~ect em hasized the first Coalition Sur e Test for evacuation. Page 78 _ R N C ~ ~ W ~ y ~ ~ .y,. ~ d a> y°~ ~ ~ d N Ol u~ ~ ~ 'C a~ = a~ y v CI f0 ~ ~ pf ~ p ~ J E Progress — 2018 UPDATED 9/1$!19 Objective — 2018-19 • The HPP LEMSA Coordinator Cynthia Frankel planned and conducted the CST Exercise June 2018 and May 2019. The EMS Branch DOC was activated. Communications was tested on ReddiNet • Multiple partners participated Alameda County EMS MHOAC, RDMHS, EMS Coordinators, hospitals, skilled nursing facilities, and other observers and evaluators PORT OF OAKLAND FULL-SCALE AIRPORT EXERCISE 2079 • Participated in planning and facilitating Oakland Airports triennial full-scale exercise • Delivered hemorrhage control training to volunteer role players COLLABORATION —DISASTER RESPONSE PARTNERS • Alameda County Office of Homeland Security and Emergency Services • Disaster Preparedness Health Coalition (DPHC) • HPP LEMSA Coordinator and HPP Coordinator (Public Health) • Region II MHOAC Coordinators (Medical Health Operational Area Coordinators • Region ABAHO Coordinators (sub-committee to Health Officers) • Health Care Services Agency Emergency Operations Council (includes Pubic Health, Environmental Health, Behavioral Health, and Emergency Medical Services) • CDPH/EMSA Pediatric Surge Workgroup PUBLIC ACCESS HEMORRHAGE CONTROL (PAHC) Project PROGRESS: • Secured grant to implement program to enhance area capability of "immediate responders" to mitigate loss of life from hemorrhage resulting from mass acts of violence or disaster • Coordinating with Oakland Airport to place bleeding control kits in all AED cabinets throughout the airport and on airport safety facility vehicles STOP THE BLEED CAMPAIGN • Continued Stop the Bleed public awareness and information campaign • Support county partners, including local trauma centers, in efforts to deliver Stop the Bleed training to community members • Promoted Stop the Bleed radio add during Stop the Bleed month and developed new relationship with iHeart Radio to further efforts and expand exposure of awareness campaign to diverse audiences • Promoted Stop the Bleed awareness and informal training to public at various community locations and events • Worked with Chabot College to develop Stop the Bleed 60+ second informational video featuring EMS Corps alumni • Working with Oakland's Violence Prevention Program to develop new awareness video featuring local survivors EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION PROJECT • Developed EMS and Clinic Field Treatment Site Co-location feasibility study design in conjunction with Public Health and HPP grant steering committee. • Conducted assessmenUmatrix in 2017-18: Community Health Center disaster medical surge plans; side by side medical operations for autonomous medical entities; and develop matrix of key components required for coordination of efforts EXERCISE SCOPE: • Two linked exercises (Tabletop and Full Scale) tested the models for side-by-side coordinated in-the-field victim stabilization between Emergency Medical Services EMS units and Communit Health Centers CHC . Page 79 c ~ N ~ d m ~ ~ d `m R ~ Q~ ~ ;! c~ ~ R o ~ ~ R ~ ~ Progress - 2018 Objective - 2018-19 ~ N W ~ N ~ a~ t' a> p~ ~ p ~, UPDATED 9/18119 ~ ~ ~ N a~ ~ 0 J ~ • Models were developed with coordinators from Alameda County EMS and Community Health Centers of the Alameda Health Consortium through an independent consultant Barbara Morita. • Full-scale exercise conducted Mav 30 and 31.2018 at three clinic locations. DISASTER RESOURCES —EQUIPMENT AND SUPPLIES MCl/MASS CASUALTY DEPLOYMENT MODULESITRAILERS • Purchased six mass casualty deployment modules in 2017-18 for existing MCI trailers with Point of Wounding (POV~ response kits and DMS command supplies. • Delivered to Alameda County EMS locations for deployment June 2018 EMERGENCY SUPPLIES • Procured approximately 6000 SWAT-T tourniquets via a UASI grant for distribution to every law enforcement officer/deputy within Alameda County. • Ailows for immediate and potentially life-saving hemorrhage control at the "point-of- woundin "- includes trainin b ALCO EMS ersonnel. 4.13 Intercounty 3 3 PROGRESS TO DATE: The local EMS agency shall develop agreements permitting Response* Alameda County EMS has developed agreements permitting inter-county response inter-county response of emergency medical transport vehicles and EMS personnel. of emergency medical transport vehicles and EMS personnel. Vehicles and personnel have responded through direct provider to provider request Objective: Work with Transportation Subgroup on mutual aid for mutual aid and must notify the EMS on-call "Duty Officer" personnel via the agreements between fire transport agencies and private Alameda County Regional Emergency Communications Center (ACRECC) based contracted providers. upon pre-identified trigger points such that the MHOAC in conjunction with the RDMHS can coordinate medical mutual aid as needed per regulation LONG-RANGE • ANDREW SULYMA, Alameda County EMS Coordinator Continued integration of BLS Providers into the County o Monitors System Operations; Contract Compliance: Non-Emergency Permitted disaster plan to assist large-scale movement of patients Ambulance Ordinance; Communications Liaison; EMS Dispatch Liaison; EBRCS Radio Communications; and Unusual Occurrence Management o Continues to monitor compliance and overall performance by all EMS Non-911 Emergency Permitted transport providers. PERMITTED NON-EMERGENCY PROVIDER • Addition of Eagle Ambulance and Sacramento Vallev Ambulance as Alameda County-permitted IFT providers and continued management of all providers under the Alameda County Ambulance Ordinance. PERMITTED NON-EMERGENCY TRANSPORT PROVIDERS —DISASTER READINESS • Continued integration of Permitted Non-Emergency Providers in to the County disaster plan to assist large-scale movement of patients • Supported the deployment of Non-emergency permitted Providers to the 2018 Napa/Sonoma fires, and provided assistance to all participants in acquiring County and State reimbursement for services rendered Refer to 4.07 Progress Update Form Page 80 c ~w N ^ 9 R d E ~ d 'cE C~ C >+ ~ a ~ ~ ~ Ro ~ ~ R~-p~ ~ Progress - 2018 Objective - 2018-19 A W ~ ~ a> p~ ~ UPDATED 9/18/19 N d d m s a~i p ~' oc ~ ~ y V ~ ~ 4•~4 Incident 3 ~ ~ PROGRESS TO DATE: (No change) The local EMS agency shall develop multi-casualty response Command Refer to EMS Field Policy 2019 for the MCI Policy plans and procedures that include provision for on-scene System ----- medical management using the Incident Command System. AMBULANCE STRIKE TEAM (AST► /DISASTER MEDICAL SUPPORT UNIT OBJECTIVE DMSU AMBULANCE STRIKE TEAM (AST)/Disaster Medical • Working with 911 ambulance provider to develop, strengthen, and maintain AST Support Unit (DMSU) and DMSU capability in alignment with EMSA policy Provide technical assistance in making elements of • Started and maintained the quarterly Region II RDMHS Ambulance Strike team MOU with EMSA operational leader course: 04/18/2018 SHORT-RANGE PLAN: AMBULANCE STRIKE TEAM LEADER (ASTL) Advise on response plan, encourage relative training • RDMHS Region II helped to conduct another Ambulance Strike Team Leader class described in EMSA documents regarding AST and as well as an EOM training session for regional stakeholders DMSU • Led 2 Ambulance Strike Team Leader (ASTL) training courses open to California LONG-RANGE PLAN: Mutual Aid Region II provider agencies credentialing approximately 50 leadership Develop and maintenance of reliable resource personnel. AMBULANCE STRIKE TEAM: • Trained several fire departments and EMS providers regionally in Ambulance Strike Team /Medical Task Force operations —approximately 50 field leadership personnel trained. o Started and maintained the quarterly Region 2 RDMHS Ambulance Strike team leader course ALAMEDA COUNTY MUTUAL AID FOR BUTTE OPERATIONAL AREA WILDFIRES -October 2019 AST TEAMS COUNTY NON-EMERGENCY PERMITTED TRANSPORT PROVIDERS: URBAN SHIELD 2018 • Novel training on K9 care and Large MCI exercise • Ambulance Strike Team exercise planned and implemented by Alameda County EMS. Ambulance Strike Team and Mobile Field Hospital all fully engaged. • Maritime interdiction scenario and tactical team integration during 2 scenarios. TACTICAL EMERGENCY MEDICAL SUPPORT ITEMS) TEAM • Maintained the routine operation of the ALCO TEMS team in responding to high threat !high consequence incidents county-wide. TACTICAL MEDICINE TECHNICIAN EDUCATION —COURSES (PLANNING AND EMSA APPROVAL CLASSES) • Completed curriculum development for and conducted the inaugural 40 hour tactical Medical Technician (TMT) course. • Developed, received POST and EMSA approval and ran our first 40 hour Tactical Medical Technician (TMT) class in Dublin. • Completed and gained statewide approval and EMS Commission approval for the Tactical Medicine Guidelines workin close) with EMSA and POST. 4.15 MCI Plans 3 3 PROGRESS TO DATE: Multi-casualty response plans and procedures shall utilize • Refer to the EMS Field Manual Guide 2019 for the MCI Policy on the Alameda state standards and guidelines. County EMS Website. 2020 MCI Policy Update implementation in progress SHORT TERM • Plans and Policies are consistent with the Standardized Emergency Management Finalize the Alameda County MHOAC Manual (BEMs) System including ICS. Page 81 'O ~ y E ~d d y C ~ ~ T ~ ~ L ~ m ~ ~ ~ R Progress — 2018 Objective — 2018-19 Ip W = d y '~ '~ a~ i~ Of ~ O ~' UPDATED 9!18!19 y ~ d a~i ~ ~ N o J ~ • The Alameda County Medical/Health Operational Area MHOAC Manual will be finalized in 2018-19. Enhanced Level: Advance Life Support: 4.16 q~S Staffing 3 PROGRESS TO DATE: (No change) All ALS ambulances shall be staffed with at least one person certified at the advanced life support level and one person staffed at the EMT-I level. 4.17 pig ~ (No Change) All emergency ALS ambulances shall be appropriately Equipment PROGRESS TO DATE: equipped for the scope of practice of its level of staffing. • Written agreements with ALS transport providers ensure appropriate ALS vehicles with ALS/BLS equipment as specified in policy. OBJECTIVE: Evaluate and im lement e ui ment and P 4 p • EMS Equipment and Supply Specifications Policy establishes the equipment that supplies that reduces pain and suffering and improves the must be stocked on each BLS and ALS vehicle. health of patient and providers. Enhanced Level: Ambulance Regulation: 4.18 Compliance 3 PROGRESS TO DATE: (No change) The local EMS agency shall have a mechanism (e. g., an Refer to Quality Improvement Plan 2019 and ALS Transport Agreements/Contracts which ordinance and/or written provider agreements) to ensure that focus on compliance with Alameda County EMS Policies. EMS transportation agencies comply with applicable policies and procedures regarding system operations and clinical care. OBJECTIVE: Ensure EMS transport provider compliance with Alameda Count olicies. Enhanced Levei: Exclusive Operating Permits: 4• ~ 9 Transportation 3 PROGRESS TO DATE: Any local EMS agency that desires to implement exclusive Plan 911 TRANSPORT — FALCK operating areas, pursuant to Section 1797.224. H&S Code, The Ambulance Transport Provider Agreement with Falck contains details of our shall develop an EMS transportation plan which addresses: EMS transportation Plan. a) minimum standards for transportation services; b) optimal Falck began 911 Emergency Ground Ambulance Service on July 1, 2019 transportation system efficiency and effectiveness; and c) use • ALCO EMS is planning an RFP process to select and implement a contract for of a competitive bid process to ensure system optimization. services to the Exclusive Operating Area (EOA) for the future. 20 4Gra~dfathering^ ~ PROGRESS TO DATE: (No change) Any local EMS agency which desires to grant an exclusive operating permit without use of a competitive process shall document in its EMS transportation plan that its existing provider meets all of the requirements for non-competitive selection " randfatherin "under Section 1797.224, H&SC. 4.21 Compliance 3 PROGRESS TO DATE: (No change} — The local EMS agency shall have a mechanism to ensure (Refer to Alameda County Quality Improvement Plan 2019) that EMS transportation and/or advanced life support QUALITY IMPROVEMENT (OI► AND MANAGEMENT OF DATA agencies to whom exclusive operating permits have been • Continued work on development and implementation of a county wide health granted, pursuant to Section 1797.224, H&SC, comply with information exchange that enables sharing of clinical data between hospitals and the applicable policies and procedures regarding system prehospital system. Continue to explore integration of this work with AC3 operations and patient care. • Successful conversion of EMS electronic health care record to NEMSIS 3.4, a state and national standard required for data gathering and submission. • Data ePCR Committee has been meeting monthly to make improvements in the data system. • Completion of the first two years data with the Cardiac Arrest Registry to Enhance Survival (CARES) • Monthly Falck QI reports -Improvements for the end user Page 82 c E y d y m m ~ .. ~ ~ z ~ ~ ~ ~ ~ m ~ R Progress - 2018 Objective - 2018-19 ip W = ,~ •~ ~ a> pf ~ UPDATED 9/18/19 ~ ~ N ° ~ ~ o -~ ~ AMBULANCE PATIENT OFFLOAD TIME (APOT) - Refer to 4.01 Progress Update Form • Implemented developed plan to reduce ambulance patient offload times at emergency departments (time from ambulance arrival to hospital staff assuming care of patients) in conjunction with EMS provider agencies, hospitals and ACRECC. • Attained and maintained notable reduction system-wide in Ambulance Patient Offload Time (APOT) with process and reporting recognized as best practice by California EMS Authority. Refer to chart below. APOT AI' HotD~tals ~b )s A x.w .. ~ ~r•r. H H.w nn. xww. N ~e a e' m io w r w r n n n~ w n n r e m m m m m e m¢ m m m m a n c a a R R R R R R R R R R R~ R R R R 9. & k S1 R R R 2 R R R R F. R R R R R k'. 8 3 8 8 .z.' ~- f ~ 3 E E B ~ `e 4~ ~ E 3 E S z~~~ 'v ~ E ? E E 2~ a ~ o E o E m 2~ g E o 2~ <~ o $ ~ < PS p ~~ LL i o Y ., -. i o i o i o N • Continued Development of Ambulance Patient Offload Time report -Monthly reports shared with hospital leadership and providers; Significant improvement in overall drop off times; • Continue to monitor the turnaround improvements from earlier this year. System Operations and Regulatory Compliance • Quarterly reporting to California Emergency Medical Services Authority (EMSA) • Working with all providers to continue to improve response time performance and address system issues. Active monitoring of performance by all providers and corresponding planning/implementation of corrective procedures related to system operations. • Clarifying our expectation (hospital, field and ACRECC) regarding ambulance patient offload time (30 min or less for transfer of care to hospitals) and implementing process control measures. Dr. Sporer, EMS Medical Director, and Lauri McFadden, EMS Director, continue to meet with hospital executive leadership regarding this issue to ensure positive results are sustained. • Alameda County EMS expects hospitals find a suitable location for patients arriving b 911 ambulance and release the crews within 30 minutes. 4•zz Evaluation 3 ~ PROGRESS TO DATE: The local EMS agency shall periodically evaluate the design EMS SYSTEM EVALUATION of exclusive operating areas. Page 83 E y ~ d a d d m R Q~ _£ R p R L ~ ` ~ ~ @ p~ ~ Progress - 2018 Objective - 2018-19 ~p W ~ N 3 ~' n> p~ r~ UPDATED 9/18!19 h ~ d~ y aTi p o ~ ~ J ~ • In July 2015, the Alameda County EMS Agency began an EMS system evaluation OBJECTIVE: Alameda County EMS evaluates the design of which ultimately resulted in the release of the RFP process for 911 EOA emergency exclusive operating area. (LONG-RANGE) ambulance services, with the goal of ensuring an EMS System driven by clinical and operational excellence as well as financial viability. Falck awarded contract. Alameda County EMS is now planning for the next RFP. E. Facilities/Critical Care -Universal Level: 5.01 Assessment of 3 Refer to previous sections and plans: The local EMS agency shall assess and periodically reassess Capabilities 1.07 (Trauma Planning) Progress Update Form 2018-19 the EMS related capabilities of acute care facilities in its • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 service area. • 5.01 (Assessment of Capabilities) Progress Update Form 2017-18 OBJECTIVES: _~_____________________ Alameda County EMS conducts assessments and PROGRESS TO DATE: reassessments of acute care facilities. Focus in 2019 - ACS VERIFICATION is now a requirement of current trauma MOUs. New MOU's and 2020 ED Pediatric Readiness. completed in 2015. • ALAMEDA HEALTH SYSTEM -HIGHLAND HOSPITAL had a consultation visit for Level 1 status in May 2016. Level 1 status was attained in 2017. " • Continue to participate in and host the RTCC. • All trauma centers successfully completed their scheduled re-verification American College of Surgeons visits in 2017. ED PEDIATRIC READINESS PROJECT • UCSF Benioff Children's Hospital and Alameda County EMS conduct ED site visits to strengthen pediatric capability to care for children for Alameda County hospitals. The 2019 and 2020 site visits emphasized the pediatric medical surge readiness and provide a pediatric mock code. • Alameda County EMS implementing MOU with UCSF Benioff Children's Hospital Oakland to continue the Pediatric Readiness Project Site Visits for 2019-2020.. • Alameda County quarterly EMSC, Pediatric Readiness, QI, and Surge Advisory Group. Next meeting scheduled October 25, 2019, • Assessment of capabilities consistent with AC EMSC regulations. ~2 Triage 8 3 Refer to previous sections and plans: The local EMS agency shall establish pre-hospital triage Transfer 1.07 (Trauma Planning) Progress Update Form 2018-19 protocols and shall assist hospitals with the establishment of Protocols"' 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 transfer protocols and agreements. • 1.23 (Inter-facility Transfer) Progress Update 2018-19 OBJECTIVE: • 1.26 (Trauma System Plan) Progress Update 2018-19 • Continue to review and revise trauma triage, transport • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 and transfer, and MCI protocols as needed. • 5.01 (Assessment of Capabilities) Progress Update Form 2017-1 S PROGRESS TO DATE: Alameda County EMS continues to have prehospital protocols and policies for triage and transfer of patients: (Refer to the 2019 EMS Field Manual) • MCI- EMS Response • Hazardous Materials • Trauma Patient Care • Burn Patient Care &criteria • AssaultlAbuse • Psychiatric and Behavioral Emergencies • Ps chiatric Evaluation — 5150 Trans orts Page 84 'D d E y d ~ ~ ~ ai £ d = ~ L ~ ~ C T 1° '~a e a~i g= ~ d m ~ ~ A Pro ress - 2018 9 Objective - 2018-19 R W ~ ~ a~ p~ $ UPDATED 9/18/19 H d d d L~ 4~ ~ ~ OC N o -~ ~ • General Transport guidelines • Crush Injury EMS FIELD MANUAL POLICY 2020 UPDATES • Refer to ALCO EMS QI Plan 2019 Addendum-1 2018 NEW POLICIES: ADMINISTRATION —OPERATIONS • TRAUMA RE-TRIAGE PROCEDURE (ADULT) -NEW JANUARY 201 E • TRAUMA RE-TRIAGE PEDIATRIC (PEDIATRIC) —NEW JANUARY X018 5150 RESPONSE • Continued developing strategies in conjunction with BHCS leadership to better manage 5150 individuals, reducing corresponding impact on the 911 emergency response system and enhancing service level to patients. BHCS and EMS together will drive forward momentum on multiple fronts including how our healthcare system as a whole meets the needs of the 5150 population. • Alameda County EMS is working collaboratively with Alameda County Behavioral Health to develop and implement the Community Assessment and Transport Team (CATf). • The CATT program will be a mobile unit working out of a SUV Chevy Tahoe and staffed with an EMT and a Licensed Behavioral Health Clinician. • The CATT team will be able to provide assessment, management, transport, and referral as appropriate to individuals presenting with mental health-behavioral emergencies in the prehospital setting. • The goal is to provide the care and services that will meet the best needs of the client, without utilizing ambulance transport, which is an expensive approach. Members on the CATT Committee are from Behavior Health Services and Alameda Care Connect, Bonita House, Falck the 911 provider, the EMS Agency, and other partners. • In April 2019, an EMS Coordinator was hired to project manage the implementation of CATT. • CATT MOUs, policies, and procedures are being developed, which includes team schedules, and the CATT training curriculum. • The oal is to have the ro ram u and runnin sometime in earl 2020. .,.03 Transfer 3 Refer to previous sections and plans: The local EMS agency, with participation of acute care Guidelines* 1.07 (Trauma Planning) Progress Update Form 2018-19 hospital administrators, physicians, and nurses, shall • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 establish guidelines to identify patients who should be considered for transfer to facilities of higher capability and • 1.23 (Inter-facility Transfer) Progress Update 2018-19 shall work with acute care hospitals to establish transfer • 1.26 (Trauma System Plan) Progress Update 2018-19 agreements with such facilities. • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 ----------------- OBJECTIVE: Continue education on guidelines to ensure PROGRESS TO DATE: patients are identified for transfer to higher capability of acute Alameda County EMS Administrative Policies focused on transfer of care are listed below: care. • Inter-facility Transfer Guidelines • CCT-Program Standards —Updated 2019 • Emergency Re-Triage to Trauma Centers • Completed EMS Surge Plan 2019 • Updated Pediatric Surge Plan 2D18 • Im lementin CA EMSC Re ulations and desi natin PedRCs Page 85 ~ y d N ~ N R E 3 ~£ OI N Ro R~' c a ~ ~ ~ ~ ~ p~ R Progress - 2018 Objective - 2018-19 ~p W = ~ ~ a~ p~ ~ UPDATED 9/18!19 N ~ m ~ ~ aTi p ~' ~ ~ N v J ~ 5.04 Specialty Care Facilities* 3 3 Refer to previous sections and plans: 1.07 (Trauma Planning) Progress Update Form 2018-19 • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 • 1.23 (Inter-facility Transfer) Progress Update 2018-19 • 1.26 (Trauma System Plan) Progress Update 2018-19 • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 The local EMS agency shall designate and monitor receiving hospitals and, when appropriate, specialty care facilities for specified groups ofemergencypatients. OBJECTIVES: PEDIATRIC READINESS PARTNERSHIP PROJECT GOALS —LONG-RANGE PLAN: • 5.04 (Specialty Care Facilities) Progress Update Form 2017-18 Implement CA EMSC Regulations. Designate PedRCs • 2019 QI Plan To conduct on-going assessments for ED pediatric • 2018-19 Trauma Plan capabilities ("Day-to-Day" and Surge Events); PROGRESS TO DATE: To review the site-visit self-assessment tool from the California Pediatric Readiness Project RECEIVING HOSPITALS AND DESIGNATED SPECIALTY CENTERS: To provide ED on-site training with expert feedback and Alameda County EM5 has designated the hospitals including specialty centers: a post site visit hospital specific customized report • Receiving Hospitals * Facilitate on-going collaboration and future training with • Trauma centers UCSF Benioff Children's Hospital. • Base Hospital SPECIALTY CENTERS • Pediatric Critical Care Center GOAL: Continue to foster and improve collaborative • 5150 Psychiatric Facilities • STEMI /Cardiac Arrest Centers relationships with all specialty emergency medical care • Stroke Centers system stakeholders, with the overarching goal to • PedRC improve patient outcomes by strengthening continuity of (PedRC -All Hospitals must have a pediatric readiness capability to receive care from dispatch to discharge: PedRC, STEMI, pediatric patients consistent with CA EMSC Regulations). Cardiac Arrest, Stroke and Trauma. REGISTRY AND DATA COLLECTION o Assist Stroke Receiving Centers in Joint CARDIAC ARREST REGISTRY - Commission re-accreditation for those that need it. • to Enhance Survival (CARES Registry) —August 2015 o Assist Trauma Centers in American College of SEPSIS ALERT PROGRAM Surgeons re-verification for Level I and II status • Screening tool designed to identify potential sepsis patients providing "sepsis alert" including UCSF Benioff Children's Hospital, for Receiving Hospitals. Goal is to begin therapy in ED as quickly as possible. Highland (Alameda Health System), and Eden). SPECIALTY CENTERS PROGRESS TO DATE CURRENT ALAMEDA COUNTY PRIMARY STROKE RECEIVING CENTERS — MOUs TRAUMA HOSPITALS - DESIGNATIONNERIFICATIONS • Kaiser Permanente Oakland ACS Verification is a requirement of the AlamedaCounty • Alta Bates Summit Campus -Oakland Trauma Center MOU (plan next contract renewal). ALL • Alameda Health System —City of Alameda three Trauma Centers completed their first re-verification • Kaiser Permanente —San Leandro in Apri12017: UCSF Benioff Children's Hospital Oakland Kaiser Permanente Fremont • Washington Hospital —Fremont -Level 1 Pediatric (TC), Sutter Eden Medical Center — • Sutter Eden —Castro Valley Level 2 Adult TC and Alameda Health Svstem • Stanford ValleyCare —Pleasanton (JC site visit Q3 2019 for Primary Stroke (Highland), FKA, Alameda County Medical Center Receiving Center Certification. Designated primary stroke center as of June 4, 2019) (Highland) —Level 1 Adult TC. CURRENT ALAMEDA COUNTY STEMI /CARDIAC ARREST RECEIVING CENTERS - LONG-RANGE PLAN: MOUs Stroke and STEMI/Cardiac Arrest Receiving Centers • Alameda Health System —Highland MOU Renewals January 2020. • Alta Bates Summit Campus —Oakland Incorporate NEW CA State STEMI and Stroke Critical • Kaiser Permanente Fremont Care System Regulations into 2020 MOU. • Kaiser Permanente Oakland Develop STEMI and Stroke Critical Care System Plans • Washington Hospital —Fremont • St. Rose that reflect and comply with NEW CA State STEMI and • Stanford Valle Care Stroke Regulations. Page 86 C ~.y., ~ ~ d `m R E ~£ R ~ L a ~ ~ ~ a ~ ~ p~ ~ Progress - 2018 ObJective - 2018-19 ~p W ~ N 3 ~ a> p~ $ UPDATED 9/18!19 N d a~ m r a~ p ~' ~ ~ ~ N v J ~ • Pediatric Receiving Center (PedRC) Hospital agreements consistent with CA EMSC Regulations. 5.05 Mass Casualty Management 3 3 Refer to previous sections and plans: 4.12 (Disaster Response) Progress Update Form 2018-19 The local EMS agency shall encourage hospitals to prepare for mass casualty management. • 4.15 (MCI Plans) Progress Update Form 2018-19 • 5.05 (Specialty Care Facilities) Progress Update Form 2017-18 OBJECTIVE: SHORT RANGE PROGRESS TO DATE: Finalize and implement the Alameda County MHOAC • Alameda County EMS encourages hospitals and prehospital providers to prepare for mass casualty events. EMS collaborates with and facilitates hospital participation in Manual Guide to support the OA Emergency Operations Plan. planning, training, conferences, and exercises throughout the year. HPP PROGRAM • The HPP program provides benchmarks and goals for medical surge and mass casualty planning. The HCC -Disaster Preparedness Health Coalition (DPHC) meets every quarter with monthly webinars. STATEWIDE MEDICAL/HEALTH FUNCTIONAL EXERCISE (SWMHE) • Hospitals participate in annual medical/health exercises to discuss and test medical surge and mass casualty management including the November 201 S and the upcoming November 21, 2019 exercise. ALAMEDA COUNTY MHOAC MANUAL and EMS SURGE PLAN The MHOAC Manual identifies roles and activities for the Health Care Services agency are identified including EMS, PH, BH, and EH. Hospital coordination functions are included. EMS is finalizing plan. Developed EMS Surge Plan 2019. COALTION SURGE TEST (CST) EXERCISE— FOCUS HOSPITAL EVACUATION • Alameda County EMS held the CST June 14, 2018 and May 30, 2019. URBAN SHIELD TRAINING — BOS did not approve further training Held Urban Shield Mass Casualty Incident full scale exercise September 2018. EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Project Full-scale exercise conducted Mav 30 and 31, 2018 at three clinic locations. • Hospitals supported this new model pilot project TRIAGE RESOURCE ALLOCATION FOR INPATIENT (TRAIN) PLANNING • Promoting the Triage by Resource Allocation for In-patients (TRAIN) project in 2018- 19. Supporting Sutter Hospital TRAIN implementation project in Alameda County • Alta Bates Summit Berkeley and UCSF Children's Hospital participated in the TRAIN Exercise held June 25, 2018 and June 27. 2019, • TRAIN and surge planning meeting held July 17, 2018 in Alameda County. DISASTER /SURGE TRAINING MHOCSA TRAINING • RDMHS developed and conducted CSTI Medical Health Operations Center Support Activities (MHOCSA) Courses in 2018 and 2019 EOM TRAINING • Conducted several Emergency Operations Manual (EOM) training classes. Hospitals participated in the training. MCI DEPLOYMENT MODULES &RESOURCES • Six MCI Deployment Modules were purchased in June 2018 for use in a mass casual event. Stored at Falck locations. Page 87 C ~ r ~ ~ d f0 R a E ~~ R o w _ ~ ~ ~ ~ m p~ ~ Progress - 2018 Objective - 2018-19 ~p W = ~ a~ p~ ~ UPDATED 9/18/19 N y m~ i a~ p m ~ ~ ~ N o J ~ 5.06 Hospital 3 3 Refer to previous sections and plans: The local EMS agency shall have a plan for hospital Evacuation" 4.12 (Disaster Response) Progress Update Form 2018-19 evacuation, including its impact on other EMS system • 4.14 (Incident Command System) providers. 5.05 (Mass Casualty Management) Progress Update Form 2018-19 OBJECTIVE: Continue to strengthen medical surge and PROGRESS TO DATE: evacuation plans. COALTION SURGE TEST (CST) EXERCISE- FOCUS HOSPITAL EVACUATION LONGE RANGE Conduct Annual Coalition Surge Test Exercise • Alameda County EMS held the first CST "Dry Run" and Test June 14, 2018 and June 27, 2018. Alta Bates Summit and ValleyCare Hospitals participated as the EVAC hospitals. The EMS Branch DOC was activated with MHOAC and RDMHS. • UCSF Benioff Children's Hospital participated in "simulated Evacuation" with EMS Branch DOC May 30, 2019. TRAIN -TRIAGE RESOURCE ALLOCATION FOR INPATIENT MHOACPROGRAM MHOAC program may be activated to support the needs of a hospital evacuation. The HPP EMSA Coordinator participates in the Hospital Evacuation Plan reviews and table top exercises at hospitals (Alameda Health System Highland 2018) BUTTE COUNTY -NORTH BAY FIRES 2018 -EMERGENCY RESPONSE Enhanced Level: Advance Life Support: 5.07 Base Hospital 3 PROGRESS TO DATE: (No change) The local EMS agency shall, using a process which allows all Designation* Alameda Health System -Highland Hospital continues to be the base hospital. eligible facilities to apply, designate base hospitals or • Alameda County EMS continues to have on-line medical direction provided by a alternative base stations as it determines necessary to base hospital - MOU contract extension with Alameda Health System (Highland provide medical direction ofpre-hospital personnel. Hospital) OBJECTIVE: Continue to monitor Base hospital and support stren thened ca abilit . Enhanced Level: Trauma Care System: 5.08 Trauma 3 Refer to previous sections and plans: Local EMS agencies that develop trauma care systems shall System Design 1.07 (Trauma Planning) Progress Update Form 2018-19 determine the optimal system (based on community need • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 and available resources) including, but not limited to: the number and level of trauma centers (including the use of • 1.23 (Inter-facility Transfer) Progress Update 2018-19 trauma centers in other counties); the design of catchment • 1.26 (Trauma System Plan) Progress Update 2018-19 areas (including areas in other counties, as appropriate); with • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 consideration of workload and patient mix; identification of • 5.05 (Specialty Care Facilities) Progress Update Form 2077-18 patients who should be triaged or transferred to a designated center, including consideration of patients who should be 2018-19 Trauma Plan triaged to other specialty care centers; the role ofnon-trauma PROGRESS TO DATE: center hospitals. including those that are outside of the Alameda County EMS Trauma Plan is submitted annually. The last submission date primary triage area of the trauma center, and a plan for was August 2018. The next submission is scheduled for September 2019. monitoring and evaluation of the system. OBJECTIVE: Alameda County_strengthens trauma care system 5.09 Public Input 3 (No change) In planning its trauma care system, the local EMS agency Refer to previous sections and plans: shall ensure input from both pre-hospital and hospital • 1.07 (Trauma Planning) Progress Update Form 2018-19 providers and Consumers. • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 OBJECTIVE: Ensure Centers of excellence for trauma care 1.23 (Inter-facility Transfer) Progress Update 2018-19 Page 88 ~ Ey y ~~ 9 d ~ ~Y £ C~ '~ = m~ C T !7 ~ Q ~ ~ ~ ~ d R o ~ ~ 10 ~ ~ Progress — 2078 ObJective — 2018-19 ~p W ~ ~' a~ p~ ~ UPDATED 9/18/19 H d d a~i t~ O~ ~ ~~ yo -+~ • 1.26 (Trauma System Plan) Progress Update 2018-19 • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 • 5.09 (Specialty Care Facilities) Progress Update Form 2017-18 • 2018-19 Trauma Plan PROGRESS TO DATE: TRAUMA HOSPITALS -NEW DESIGNATIONSNERIFICATIONS ACS Verification is now a requirement of the Alameda County Trauma Center MOU next contract renewal Jul 2021 . 'chanced Level: Pediatric Emergency Medical and Critical Care System: ~ Pediatric 3 Refer to previous sections and plans: Local EMS agencies that develop pediatric emergency System Design 1.07 (Trauma Planning) Progress Update Form 2018-19 medical and critical care systems shall determine the optimal • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 system, including.• number and role of system participants. particularly of emergency departments; the design of • 1.23 (Inter-facility Transfer) Progress Update 2018-19 catchment areas (including areas in other counties, as • 1.26 (Trauma System Plan) Progress Update 2018-19 appropriate); with consideration of workload and patient mix; • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 identification of patients who should be primarily triaged or • 5.01 (Assessment of Capabilities) Progress Update Form 2017-18 secondarily transferred to a designated center, including PROGRESS TO DATE: consideration of patients who should be triaged to other specialty care centers; identification of providers who are CA EMSC REGULATIONS AND PENDING PEDIATRIC SURGE ANNEX qualified to transport such patients to a designated facility; • Monitoring status of CA EMSC Regulations EMSA implementation plan Identification of tertiary care centers for pediatric critical care • Monitoring status of CA EMSA/CDPH Pediatric Surge Annex to Patient Movement and pediatric trauma; the role of non-pediatric specialty care Plan. Prepared to implement Pediatric System Design changes to strengthen hospitals including those which are outside of the primary program once the state implementation plan and surge annex finalized /approved. triage area, and a plan for monitoring and evaluation of the HOSPITAL PEDIATRIC CAPABILITY AND READINESS system. • Hospitals —Required to have pediatric receiving center readiness capability (PedRC) ALAMEDA COUNTY EMS FOR CHILDREN • Pediatric Critical Care Trauma Center —Level 1 — UCSF Benioff Children's Hospital BENCHMARKS: is the designated Trauma Center Implementation EMSC Regulations wirh PedRC Policy PEDIATRIC QI - CQI DATA COLLECTION and agreements -CHILDREN INEGRATED IN EMS QI DATA COLLECTION: Ensure pediatric ALS/BLS equipment and supplies • Data update implementation and report dissemination provided as follows: Adopt evidence based pediatric policies and protocols o APOT Report Leverage hospitals to strengthen pediatric readiness for o Change in Wall time- control chart "day to day" and medical surge readiness o QI Reports =Pediatric Destinations/Transports (by Primary Impression); Ensure pediatric competency Trauma Reports and Psych patients Strengthen pediatric medical surge and disaster plans o ED Site Visit Reports including the Children's Disaster CONOPs (Annex to OA First Watch EOP) and HCC Pediatric Response Plan Annex ALAMEDA COUNTY EMS POLICIES AND PROCEDURES Ensure pediatric resources are disseminated to - EMSC AUDIT PROCESS INTEGRATED IN EMS QI ACTIVITIES healthcare partners via Alameda County EMS Website; • Alameda County QI Plan 2019 (EMSC QI integrated in QI Plan) googlist serve, and coalitions/committees • PedRC Policy consistent with EMSC Regulations Ensure Pediatric Quality Improvement • Hospital Responsibilities Ensure Injury Prevention and education Projects • Policy and Skills Competency Pediatric Medical Surge capability and system-wide • Trauma Audit Process Policy readiness • Unusual Occurrence Policy Sustain EMSC, Pediatric Readiness, QI, and Surge • Pediatric Readiness Reports -Provided post Hospital ED Site Visits Advisory Committee EMS STAFF QI ACTIVITIES WITH FOCUS ON CHILDREN AND PEDIATRIC TRANSPORTS INCLUDE: Page 89 E Y d N 41 (p R ~ d R~ C i, ~ Q~ ~ ~ ~ d ~ ~ ~ ~ Progress — 2018 Objective — 2018-19 ~ W 3 y ~ 'r d p~ ~ UPDATED 9!18/19 y ~01 d d t~ O ~' ~ ~ ~ N o J ~ • Contract compliance monitoring — UCSF Benioff Children's' Hospital Pediatric Readiness Project. Development of new agreements —Pediatric Readiness Project with UCSF Benioff Children's Hospital • Review —Unusual occurrence impacting children process INVESTIGATIONS • Investigation of all incidents reported via the Alameda County Unusual Occurrence reporting process, and coordination with all EMS providers and allied agencies to provide educational follow-up or disciplinary actions (where applicable). • Tracked, investigated, and managed numerous Unusual Occurrences (real/potential reported threats to health and safety as per State regulation) reported to the EMS Agency • EMS QI Coordinator Role collaboration with EMS for Children Coordinator • Monitor hospital bypass and ambulance "wait times" —with consideration for children PEDIATRIC SURGE PLAN • Completed, disseminated and tested pediatric medical surge plan in SWMHE November 2018. PEDIATRIC COMMUNICATIONS - REDDINET • Developed customized assessment polls with pediatrics • Conducted training at multiple hospital sites during the ReddiNet training. Practice with pediatric scenarios and customized polling. PEDIATRIC INTEGRATION IN EXERCISES STATEWIDE MEDICAUHEALTH EXERCISE (SWMHE) —NOVEMBER 2018 • The goals included testing EOC coordination, pediatric medical surge. and communications with cross sector healthcare partners. PEDIATRIC READINESS PROJECT — ED SITE VISITS • Emergency Department Pediatric Readiness Project —conducted ED Site Visits with UCSF Benioff Children's Hospital. All hospitals scheduled 2019. • MOU with UCSF Benioff Children's Hospital to continue Pediatric Readiness Site Visits 2019. • Pediatric Site Visits provided data on trauma re-triage. Educating all receiving hospitals on Trauma Re-triage policy. ALAMEDA COUNTY CHILDREN'S DISASTER CONOPS • Supporting planning to finalize Children's Disaster CONOPs -Annex to OA EOP CDPH / EMSA PEDIATRIC SURGE PROJECT • Supporting EMSA / CDPH Pediatric Medical Surge Project • Developing HCC Pediatric Surge Response Annex for coalition partners • Developed CA Children's Disaster CONOPs —Draft Framework &Local Pediatric Readiness and Surge GNPs at September 2019 CHA Conference ALAMEDA COUNTY EMS POLICIES • 2019 EMS Field Manual —Reviewed and updated pediatric policies as needed NEW POLICIES -ADMINISTRATION —OPERATIONS • TRAUMA RE-TRIAGE PEDIATRIC (PEDIATRIC) —NEW JANUARY 2018 2019-2020 SUMMARY OF FIELD MANUAL POLICY UPDATE -PROPOSALS EMS FIELD MANUAL -PEDIATRIC SECTIONS • Refer to .ALCO EMS QI Plan Addendum-1 - 2019 TRAIN —TRIAGE RESOURCE ALLOCATION FOR INPATIENT Page 90 _ E y ~ d y ~ ~ d R a E _~ Ro ,`s~ 'o e v~ ~ ~ y ~ ~ ~ m p~ ~ ~ Progress - 2018 Objective - 2018-19 R W ~ N ~ ~ ~ p~ $ UPDATED 9118/19 fA ~ d ~ y a> p ~' 0 ~ V J E • Promoting the Triage by Resource Allocation for In-patients (TRAIN) project in 2019. Supporting Sutter Hospital TRAIN implementation project in Alameda County • Alta Bates Summit Berkeley and UCSF Children's Hospital participated in the TRAIN Exercise held June 25, 2018 and June 26, 2019 SCHOOL CAMPAIGN FOR EMERGENCY PLANNING • Emergency School Guidelines -Dissemination • Supported CA Child Care Disaster Plan project; EMSC Coordinator advisor to project; developed "Train the Trainer" Curriculum and disseminated to regional Injury Prevention groups 2018 PEDIATRIC INTEGRATION -COMMITTEES EMSC. Pediatric Readiness, QI, and Surge Advisory Committee -quarterly meetings (June 27, 2018; Oct. 26, 2018; Jan. 25, 2019; April 26, 2019; July 26, 2019; October 25, 2019). • Updated Pediatric Resources and ensure access with system partners via ED Receiving Hospital Committee, HCC -Disaster Preparedness Coalition (DPHC), QI Meetings, and Hospital Disaster Preparedness Committees) Ensure pediatric issues are addressed in all EMS programs: Quality Improvement, Trauma. Disaster, Injury Prevention, and Region II ABAHO Medical Shelter Project PEDIATRIC RESOURCES AND SUPPLIES • Six MCI Deployment Modules were purchased in June 2018 with POW Kits for adults and children. 5.11 Emergency 3 3 Refer to previous sections and plans• Local EMS agencies shall identify minimum standards for Departments 1.07 (Trauma Planning) Progress Update Form 2018-19 pediatric capability of emergency departments including: • 1.19 (Policies, Procedures, Protocols? Progress Update 2018-19 staffing, training, equipment, identification of patients for iyhom consultation with a pediatric critical care center is • 1.23 (Inter-facility Transfer) Progress Update 2018-19 appropriate, quality assurance/quality improvement, and • 1.26 (Trauma System Plan) Progress Update 2018-19 data reporting to the local EMS agency. • 1.27 (Pediatric System Plan) Progress Update Form 2018-19 '" Objective: Strengthen pediatric capability to care for children • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 for Alameda County hospitals 5.10 (Pediatric System Design) Progress Update Form 2018-19 ** PROGRESS TO DATE: LONG -RANGE GOALS- PEDIATRIC READINESS PROJECT ED PEDIATRIC READINESS PROJECT - CA EMSC REGULATIONS • To conduct a pediatric mock code demonstration in -IMPACT ON HOSPITAL EDS hospitals; To conduct an assessment for ED pediatric • Implementing CA EMSC Regulations with ALL hospital PedRC policy and capabilities ("Day-to-Day" and Emergency /Medical agreements. Surge Events); To review the site-visit self-assessment • Conducting pediatric readiness site visits. All hospitals scheduled in 2019. With tool from the California Pediatric Readiness Project and UCSF Benioff Children's hospital Oakland, assessed Highland (AHS); Stanford the result recommendations 2019; To provide an ED on-ValleyCare; Kaiser Fremont; San Leandro (AHS); and Washington Hospitals in 2019. site training with expert feedback and a post site visit Starting September 2019, additional site visits planned with Kaiser San Leandro; hospital specific customized report which includes Kaiser Oakland; St. Rose: and Alameda (AHS) Hospitals recommendations on strategies for improvement; and to Hospital Pediatric Emergency Care Coordinators (PECCs) invited to EMSC, facilitate on-going collaboration and future training with Pediatric Readiness, QI, and Surge Advisory Committee quarterly meetings. UCSF Benioff Children's Hos ital. 5•~2 Public Input 3 (No Change) In planning its pediatric emergency medical and critical care PROGRESS TO DATE: system, the local EMS agency shall ensure input from both • Various committee collaborations are continuing to ensure pediatric emergency care pre-hospital and hospital providers and consumers and critical care public input and EMS agency representation as follows: EMS Quality Council; Emergency Medical Oversight Committee EMOC; Receiving Hospital Committee; Trauma Audit Committee; Regional Trauma Audit Committee; Data Steering Committee; ePCR Change Committee; EMS Section Chiefs Committee; Alameda Coun Fire Chiefs Committee; EMSAAC/EMDAAC; CA EMS Page 91 C 7 « N ~ '~ ~ ~ ~ ~ _ vai m ~ ~ d ~ ~ ~ ~ Progress — 2018 Objective - 2018-19 ~ w = ~ ~ ~ a`~i p~ ~ UPDATED 9/18119 N ~ ~ ~ N a~ p ~`o~ ~ J ~ for Children TAC Meeting; LEMSA EMSC, Pediatric Readiness, QI, and Surge Advisory Meeting; Western Regional Pediatric Alliance for Emergency Management, and other ad-hoc committees (ie. ReddiNet and ABAHO Medical Shelter Workgroup Committee Enhanced Level: Other Specialty Care Systems: Survival to discharge over the next few years. 5.13 Specialty 3 3 3 Refer to previous sections and plans: Local EMS agencies that develop Specialty Systems of Care System Design 1.07 (Trauma Planning) Progress Update Form 2018-19 shall determine the optimal system (based on community need. available resources and current available evidence) • 1.19 (Policies, Procedures, Protocols) Progress Update 2018-19 including, but not limited to: • 1.23 (Inter-facility Transfer) Progress Update 2018-19 STROKE RECEIVING CENTERS 1.26 (Trauma System Plan) Progress Update 2018-19 Primary Stroke Receiving Centers, 1.27 (Pediatric System Plan) Progress Update Form 2018-19 ' ` Thrombectomy Capable Stroke Centers • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 Comprehensive Stroke Centers • 5.04 (Specialty Care Facilities) Progress Update Form 2018-19 ** STEMI/CARDIAC ARREST RECEIVING CENTERS • 5.10 (Pediatric System Design) Progress Update Form 2018-19 *• ECMO Capable SRC/CARC 5.13 (Specialty System Design Progress Update Form 2017-18 ** TRAUMA RECEIVING CENTERS PROGRESS TO DATE: Pediatric STEMI/CARDIAC ARREST RECEIVING CENTERS Adult • Changed STEMI to STEMI/Cardiac Arrest Receiving Centers. Appropriate (BLS, ALS, CCT) IFT network for ALL Shared Hospital Specific Outcome Data for Stroke, STEMI, Cardiac Arrest specialties Outcomes. SHORT/LONG-RANGE PLAN: • Cardiac Arrest Registry to Enhance Survival implemented in late 2015. Support and help coordinate any or ALL of our existing • All MOU's for specialty receiving hospitals were updated or in progress in 2018-19 Stroke Centers in becoming Thrombectomy capable by • 2020 MOU renewal for specialty receiving hospitals (Stroke, STEMI, Cardiac Arrest) 2020 -REGISTRY AND DATA COLLECTION - SHORT/LONG-RANGE PLAN: CARDIAC ARREST REGISTRY Support help coordinate any or ALL of our existing • Cardiac Arrest Registry to Enhance Survival (CARES Registry) —August 2015 STEMI/Cardiac Arrest Centers in becoming ECMO • CARES data collection integrated into ePCR in June 2016 capable or at minimum have written agreements with Completed first three years of o~cial participation in CARES data collection and was local ECMO receiving hospitals by 2020 included in National 2016-2918 CARES reports SHORT/LONG-RANGE PLAN: SEPSIS ALERT PROGRAM Incorporate new CA State STEMI and Stroke Critical Care • Screening tool designed to identify potential sepsis patients providing "sepsis alert" System Regulations into up-coming 2020 specialty center for Receiving Hospitals. Goal is to begin therapy in ED as quickly as possible. agreements (MOUs) to comply with requirements. -SPECIALTY CENTERS Current ALAMEDA COUNTY PRIMARY-STROKE RECEIVING CENTERS — CA EMS FOR CHILDREN REGULATIONS AND PENDING EOM PEDIATRIC SURGE ANNEX MOUs SHORT RANGE PLAN • Kaiser Permanente Oakland • Alta Bates Summit Campus -Oakland Monitoring status of proposed pending CA EMSC • Alameda Health System —City of Alameda Regulations specific to QI and pediatric receiving • Kaiser Permanente —San Leandro hospital designation requirements. • Kaiser Permanente -Fremont Monitoring status of CA Medical and Public Health EOM • Washington Hospital —Fremont -Pediatric Surge Annex for receiving hospital • Sutter Eden —Castro Valley designations • Stanford ValleyCare-Pleasanton had an initial JC site visit Q3 2019 for Primary • Prepared to implement Pediatric System Design Stroke Receiving Center Certification. As of September 4, 2019. designated as changes to strengthen program once the regulations primary stroke center. and surge annex finalized and approved to include pediatric data exchange with non-pediatric receiving hos itals. Page 92 'C C d y3 d vii ~~ m ld s ~ d ~ ~ ~ = ~ ~ L T z ~ d ~ _ `m ~ ~ m Progress — 2018 Objective — 2018-19 ~p W ~ y ~ ~ a~ pf ~ UPDATED 9/18/19 N ~ m y = a~ p ~ ~ ~ ~ H ~ J ~ Current ALAMEDA COUNTY STEMI /CARDIAC ARREST RECEIVING CENTERS • Alameda Health System —Highland • Alta Bates Summit Campus —Oakland • Kaiser Permanente Fremont • Kaiser Permanente Oakland • Washington Hospital —Fremont • St. Rose • Stanford ValleyCare The American Heart Association has recommendations regarding cardiovascular patients (STEMI, STROKE. and CARDIAC ARREST. All Alameda County "specialty" patient assessment, treatment, triage, and transport protocols meet local and national recommended guidelines. STROKE RECEIVING CENTERS — • Alameda County EMS ensures that patients who are experiencing a possible cerebral vascular accident (Stroke) on scene, detected by clinical assessment (Cincinnati Stroke Scale), are transported to an EMS designated hospital (MOU in place) for specialty diagnostics and treatment: CT / CTA and if needed, IV fibrinolytic and or transfer to a thrombectomy capable center for IR services. STEMI /CARDIAC ARREST RECEIVING CENTERS (CARL) — Alameda County EMS ensures that patients who are experiencing a possible ST- elevation myocardial infarction (STEMI) receive expedited specialty care. An out-of- hospital STEMI is detected by clinical exam and 12-lead electrocardiogram that is transmitted to the closest appropriate STEMI Receiving Center (SRC). The patient is then transported to that EMS designated SRC (MOU in place) for specialty diagnostics and treatment: coronary angiogram and if needed a Primary Percutaneous Coronary Intervention (PCI). • Alameda County EMS also ensures that patients who experience out-of-hospital cardiac arrest on scene or during transport and received attempted resuscitation with any return of spontaneous circulation (ROSC) or presented with an initial or recurrent shockable rhythm (VENT) are transported to the same EMS designated SRC/CARCs (MOU in place). Both STEMI and Cardiac Arrest patients are transported to a SRC/CARC since these patients frequently need common interventions. CA EMS FOR CHILDREN PROPOSED REGULATIONS AND PENDING EOM PEDIATRIC SURGE ANNEX • Implementing PedRC requirements consistent with CA EMSC Regulations Monitoring status of CA Medical and Public Health Pediatric Surge Annex • Prepared to implement Pediatric System Design changes to strengthen program once the regulations and surge annex finalized and approved. HOSPITAL PEDIATRIC CAPABILITY AND READINESS • Receiving hospitals —Required to have pediatric readiness capability PedRC agreements • Pediatric Critical Care Trauma Center —Level 1 — UCSF Benioff Children's Hospital is the designated Trauma Center RAPID RESPONSE CASE MANAGEMENT (RRCM) FOR OLDER ADULTS Page 93 ~ d y E d 'c d N e~ ~ T R C Q~ ~ ;? E ~ ~¢ o ~ ~ R ~-pC ~ Progress - 2018 Objective - 2018-19 1~ W ~ y ~ ~ ~ p~ ~ °7 UPDATED 9/18/19 V! d'N ~ d g ~ ~ ~ o o J ~ • Collaborating with Day Break (senior support agency) and St. Rose Hospital to develop a program that facilitates a transitional case manager to assist older adults who frequently utilize emergency resources in an effort to help these patients gain access to more appropriate care, and avoid crisis and non-urgent use of emergency resources • Collaboration includes exploring and adopting viable screening tool for EMS to identify older adults at risk for this specialized care to support an expeditious res onse b the case mana er 5.14 Public Input 3 (No change) - Refer to EMS System Plan 2015 In planning other specialty care systems, the local EMS agency shall ensure input from both pre-hospital and hospital providers and consumers. F. Data Collection/System Evaluation -Universal Level: 6.01 Qp/Q~ program 3 3 ~ Refer to previous sections and plans: The local EMS agency shall establish an EMS quality • 1.12 (Review and Monitoring) Progress Update Form 2018-19 ' ° assurance/quality improvement (QA/QI) program to evaluate • 1.18 (QA/Q1) Progress Update Form 2018-19 ** the response to emergency medical incidents and the care provided to specific patients. The programs shall address the • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 tota(EMS system, including all pre-hospital piovidei • 2019 QI PLAN agencies, base hospitals. and receiving hospitals. It sha// PROGRESS TO DATE: address compliance with policies, procedures, and protocols. • Complete Implementing ESO EHR systemwide and identification of preventable morbidity and mortality, and • Improved EMSA Core Measures accuracy shall utilize state standards and guidelines. The program • Expanded Tableau ad hoc reporting capability shall use provider based QA/QI programs and shall • Expanded First Watch Analytics coordinate them with other providers. ePCR -DEFINITIVE NETWORKS INCORPORATED OBJECTIVE: • Hosting I Training Services -Contract through June 2021. • Reduce pain and suffering and improve the health of our QUALITY IMPROVEMENT -BENCHMARKS AND PROGRESS UPDATES patients SHORT RANGE PLAN: • Continued work on development and implementation of a county wide health Improve Core Measures accuracy in Tableau information exchange that enables sharing of clinical data between hospitals and the Implement ESO EHR systemwide prehospital system. Continue to explore integration with Alameda Countv Care Establish reports that assess the effect of prehospital Connect. a Whole Person Care pilot program. Expand Tableau ad hoc reporting capability for EMS AMBULANCE PATIENT OFFLOAD TIME (APOT) - July 2018-June 2079 Expand First Watch Analytics LONG RANGE PLAN: • Implemented plan to reduce ambulance aatient offload times at emergency Integrate prehospitai data with hospital data (via HIE departments (time from ambulance arrival to hospital staff assuming care of patients) and other methods) to assess patient outcomes and the in conjunction with EMS provider agencies, hospitals and ACRECC. effect of prehospital interventions NEXT PAGE Page 94 a d ~ c m~ W~ C T z ~ ~ ~ m ~ @ ~ ~ Progress — 2018 Objective — 2~1 &19 R W 3 3 'C ~ of w UPDATED 9/18/19 N ~ ~~ y ~ o j o E 1VOT AlI HosplGls R R K R R R R R R t3 ti N .1 n R&£ R R R R r~ d R R R A Q R R R R A. ° L f B E~ it Y S y ~, ° E E E E C ~i' e S y ~~ S$ P E C ~' e S 'si o z ~ a: ~ a$ E 4 s ~ ~ o G s n a a ~ ,„ _ APOT PLAN • Continued Development of Ambulance Patient Offload Time report -Monthly reports shared with hospital leadership and providers; Significant improvement in overall drop off times; Completed a meeting with the leadership of Eden Hospital • Continue to monitor the turnaround improvements from earlier this year. System Operations and Regulatory Compliance • Quarterly reporting to California Emergency Medical Services Authority (EMSA) • Attained notable reduction system-wide in Ambulance Patient Offload Time with process and reporting recognized as best practice by California EMS Authority CQI DATA COLLECTION: • Data update implementation and report dissemination provided as follows: o APOT Report o Change in Wall time- control chart o QI Reports =Trauma Reports and Psych patients o First Watch ~02 Prehospital 3 3 3 Refer to previous sections and plans: Pre-hospital records for all patient responses shall be Records 1.12 (Review and Monitoring) Progress Update Form 2018-19 *' completed and forwarded to appropriate agencies as defined • 1.18 (QA/QI) Progress Update Form 2018-19 *' by the local EMS agency. • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 OBJECTIVE: Through scientific data collection and analysis, • 6.01 (QAIQI Program) Progress Update Form 2018-19 measurably assess prehospital impact on reducing pain and • 6.02 (Prehospital Records) Progress Update Form 2017-18 suffering SHORT RANGE PLAN: • 2019 QI PLAN Complete ESO EHR implementation systemwide --------- Improve Core Measures accuracy in Tableau PROGRESS TO DATE: . Establish reports that assess the effect of prehospital ePCR —DEFINITIVE NETWORKS INCORPORATED HOSTING / Trai~in4 interventions by analyzing patient VS changes • Contract extension to June 2021. Expand Tableau ad hoc reporting capability for EMS • Support for ePCR system —Using "Definitive Networks Incorporated,,.LONG RANGE PLAN: Provide fully functional ePCR Training System, business Intelligence Portal Integrate prehospital data with hospital data (via HIE and other methods) to assess patient outcomes and the • Tier 4 Hosting Center and redundant hardware for servers effect of prehospital interventions Alameda County provider QI plans updated annually. (Refer to 6.01 and 6.03) Page 95 a d ' c Eq~ ~~ af~ R 'a Q E ~a e~+ ~ ~ ~ ~ d oC ~ R Progress - 2078 Objective - 2018-19 !=6 W 3 ~ 'C a> 01 w UPDATED 9/18!19 N ~ ~ai ~ y uTi J ~' 0 ~ o ~ 6.03 Prehospital 3 3 Refer to previous sections, plans, and website: Audits ofpre-hospital care, including both system response Care 1.12 (Review and Monitoring) Progress Update Form 2018-19 *" and clinical aspects, shall be conducted. Audits 1.18 (QA/QI) Progress Update Form 201$-19 '* OBJECTIVES: • 5.01 Assessment of Capabilities) Progress Update Form 2018-19 LONG-RANGE PLAN • 6.01 (QA/QI Program) Progress Update Form 2018-19 Maintain the one-stop data source for all clinical system • 6.03 (Prehospital Records) Progress Update Form 2017-18 data to better enable Alameda Gounry EMS to conduct detailed research with FRALS and transport data • 2019 QI PLAN *' integrated into the same system. This will reduce the • APOT Reports -Alameda County EMS Website: time needed to implement queries and will also ensure http://ems.acgov.orglAboutEMSSvstem/AboutEMSSvstem page? that clinical data is not under or over counted due to the _--~__— enhanced ability to match FRALS and transport data to PROGRESS TO DATE: one patient. ALAMEDA COUNTY EMS POLICIES AND PROCEDURES describe the audit Continue plan with audits to reduce ambulance patient rop C@SS offload times at emergency departments (time from • Alameda County QI Plan 2018-19 ambulance arrival to hospital staff assuming care of Base Hospital QI Responsibilities patients) in conjunction with EMS provider agencies, • Base Hospital Responsibilities hospitals and ACRECC. • Hospital Responsibilities • Policy and Skills Competency • Trauma Audit Process Policy • Unusual Occurrence Policy • Pediatric Readiness Reports -Provided post Hospital ED Site Visits EMS STAFF QI on-going activities include: • Contract compliance monitoring of all Tine items • Development of new agreements • Reviewing response time audits by provider • Reviewing provider audits • Participate in audits • Review- Unusual occurrence process • EMS QI Coordinator Role • Monitor hospital bypass and ambulance "wait times" • Ongoing implementation of plan with audits to reduce ambulance patient offload times at emergency departments (time from ambulance arrival to hospital staff assuming care of patients) in conjunction with EMS provider agencies, hospitals and ACRECC. EMS FOR CHILDREN • Reviewing pediatric call volume, destination, chief complaints, and system impact. Contact EMS office for EMSC Data Re orts 2018-19 if needed. 6.04 Medical 3 3 Refer to arevious sections, plans, and website: The local EMS agency shall have a mechanism to review Dispatch 1.12 (Review and Monitoring) Progress Update Form 2018-19 * * medical dispatching to ensure that the appropriate level of 1.18 (QA/QI) Progress Update Form 2018-19 *' medical response is sent to each emergency and to monitor the appropriateness of pre-arrival /post dispatch directions. • 3.04 (Dispatch Center) Progress Update Form 2018-19 " • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 OBJECTIVE: • 6.01 (QAIQI Program) Progress Update Form 2018-19 Have readily available data to review disaatch response priority and pre-arrival post dispatch instructions. • 6.04 (Prehospital Records) Progress Update Form 2017-18 SHORT RANGE PLAN 2019 QI PLAN *' Ensure an ongoing QA/QI feedback loop with dispatch PROGRESS TO DATE: agencies. QUALITY IMPROVEMENT PLAN rage yti yd .-. R E 7 +N„ E°' Ro wT L a ~ ` ~ d ~ @ p~ ~ Progress - 2018 Objective - 2018-79 R W ~ ~ a~ p~ ~ UPDATED 9/18/19 ~ ~ N ~ o J ~ • Calls are monitored and reviewed for appropriateness. • In an effort to coordinate and standardize emergency medical dispatch functions throughout the County, Alameda County EMS has established a Medical Dispatch Review Committee that is comprised of representatives from ACRECC and the Oakland Fire Department Dispatch center as well as field personnel, the EMS Director, EMS Medical Director and provider agency and leadership. The establishment of this committee has assisted in standardizing the assignment of EMS resources throughout the county. No chan e F.05 Data 3 3 Refer to previous sections, plans, and website: The local EMS agency shall establish a data management Management 1.12 (Review and Monitoring) Progress Update Form 2018-19 *' system that supports its system-wide planning and evaluation System* 1.18 (QA/QI) Progress Update Form 2018-19 *' (including identification of high risk patient groups) and the QA/QI audit of the care provided to specific patients. It shall • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 be based on state standards. • 6.01 (QA/QI Programs Progress Update Form 2018-19 • 6.05 (Prehospital Records) Progress Update Form 2017-18 OBJECTIVE: (SHORT-RANGE) 2019 QI PLAN *' Create cone-stop data source for all clinical system PROGRESS TO DATE: data to better enable ALCO EMS to conduct detailed • Alameda County EMS has implemented a NEMSIS v3.4 single data collection (ESO research with FRALS and transport data integrated into EHR) countywide and has finished training for the FRALS agencies. the same system. This will reduce the time needed to • ePCR —DEFINITIVE NETWORKS INCORPORATED HOSTING / Training Services implement queries and will also ensure that clinical data • Definitive Networks Incorporated Data Hosting /Training Services contract extension is not under o over counted due to the increased ability to June 2021 to match FRALS and transport data to one patient. • QUALITY IMPROVEMENT -DATA MANAGEMENT SYSTEM — "SINGLE ENTRY - (No Change) POINT" — o FRALS and transport agencies report on one data management system for patient care which provides a very streamlined data reporting process for the Alameda County EMS system. Our system with a NEMSIS v3.4 single electronic Aatient care reporting platform allows for unprecedented QI and a comprehensive overview of our EMS System. • Initiated active participation in quality improvement meetings at ALL Trauma Centers (UCSF Benioff Children's Hospital, Highland (Alameda Health System), and Eden Hospital). Promote Pediatric Receiving Centers (PedRCs) participation in LEMSA EMSC, QI, and Surge Advisory Meetings and required pediatric site visits 6.06 System Design 3 Refer to previous sections, plans, and website: The local EMS agency shall establish an evaluation program Evaluation 1.12 (Review and Monitoring) Progress Update Form 2018-19 *' to evaluate EMS system design and operations, including 1.18 (QA/Q1) Progress Update Form 2018-19 ** system effectiveness at meeting community needs, appropriateness of guidelines and standards, prevention • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 strategies that are tailored to community needs, and • 6.01 (QAIQI Program) Progress Update Form 2018-19 assessment of resources needed to adequately support the 2019 QI PLAN ~* system. This shall include structure, process, and outcome _____________~,________ evaluations, utilizing state standards and guidelines. PROGRESS TO DATE: NEW OBJECTIVE: EMS SYSTEM EVALUATION - RFP Plan for new RFP Process • In July 2015, the Alameda County EMS Agency began an EMS evaluation process in preparation to release the RFP for 911 EOA emergency ambulance services, with the goal of advancing an EMS System that is operationally and clinically excellent as well as financial) sustainable. Contract awarded to Falck. Plannin for future RFP. 6.07 Provider 3 Refer to EMS plans: The local EMS agency shall have the resources and authority Participation 2019 QI PLAN '* to require provider participation in the system-wide evaluation Page 97 _ y ~ y N ~ d d l6 ~ a ~ ~ ~ ~ Tc ~ ~ d ~ ~ ~ m ~ m Progress — 2018 Objective — 2018-19 ~p W = y ~ ~+ N p~ r,~ UPDATED 9/18/19 N ~ d d = a~ p ~' ~ gOC H v J ~ ------------------ program. PROGRESS TO DATE: (Refer to 6.06 above.) OBJECTIVE: EMS SYSTEM EVALUATION . Establish an evaluation of the EMS System Design in • In July 2015, the Alameda County EMS Agency began an EMS evaluation process preparation for the release of a new RFP in preparation to release a RFP for 911 EOA emergency ambulance services, with Review Falck contract. Ensure provider participation in the goal of advancing an EMS System that is operationally and clinically excellent as system evaluation. well as financially sustainable. Falck was awarded contract. ALCO EMS planning for future RFP. • The 2019 QI Ian re uires rovider artici ation ins stem-wide QI activities. ~$ Reporting 3 Refer to EMS plans: The local EMS agency shall, at least annually, report on the • 2019 QI PLAN * * results of its evaluation of EMS system design and operations to the Boards) of Supervisors, provider agencies, and PROGRESS TO DATE: Refer to 6.06 and 6.07 above Emergency Medical Care Committee(s). EMS SYSTEM Evaluation OBJECTIVE: EMERGENCY AMBULANCE AND FIRST RESPONDER SERVICES - . Alameda County will continue to report to EMSA and CONTRACTS BOS on the contract evaluations for 9-1-1 and first • Alameda County EMS is responsible for the procurement, provision and approval of responder); and RFP planning progress. advanced life support emergency ambulance and first responder services that includes contracts with Falck and the cities throughout Alameda County. Each of these contracts contain extensive operational and clinical performance reporting requirements enabling the EMS Agency to assure consistent and high quality provision of service and care to patients. Enhanced Level: Advanced Life Support: 6.09 ALS Audit 3 3 Refer to 2019 QI PLAN `* The process used to audit treatment provided by advanced ______________~_~~~__ life support providers shall evaluate both base hospital (or PROGRESS TO DATE: alternative base station) and pre-hospital activities. • EMS QI Plan 2018-19 defines the audit process • EMS Policies require assessment of Unusual Occurrences OBJECTIVE: Future phases of the data project will include • Alameda County EMS conducts audit of base hospital processes and outcomes linking the hospital data with prehospital data • All ALS providers are using a unified data collection and reporting system (ESO and LONG-RANGE PLAN Tableau) in 2019. Alameda County EMS has implemented a NEMSIS v3.4 single data collection (ESO ~ Integrate prehospital data with hospital data (via HIE Data Systems RescueNet ePCR) countywide and has finished training for the and/or other methods) to assess patient outcomes and FRALS agencies. the effect of hospital interventions ePCR —DEFINITIVE NETWORKS INCORPORATED HOSTING /Training Services Integrate pediatric patient disposition of select patients ~ as identified by CA EMS for Children regulations — QI • Definitive Networks Incorporated Data Hosting /Training Services contract extension requirements. to June 2021 • Facilitate PedRC policy and signed hospital agreements. (Consistent with CA EMSC re ulations . Enhanced Lavel: Trauma Care System: 6.10 Trauma 3 ~ (No Change) — The local EMS agency, with participation of acute care System Refer to previous sections and plans• providers, shall develop a trauma system evaluation and data collection program. including.' a trauma registry, a mechanism Evaluation 1.07 (Trauma Planning) Progress Update Form 2018-19 to identify patients whose care fell outside of established • 1.26 (Trauma System Plan) Progress Update 2018-19 criteria, and a process for identifying potential improvements • 5.01 (Assessment of Capabilities) Progress Update Form 2018-19 to the system design and operation. Page 98 C ~ ~ N d N n CI fp `a a E Em ~a c>. ~ ~ L ~ d ~ ~ ~ ~ Progress - 2018 Objective - 2018-19 10 iyi 7 N '~ ~ a~ of ~ UPDATED 9118/19 0 ~ o ~ • 5.04 (Specialty Care Facilities) Progress Update Form 2018-19 *' • 6.10 (Specialty System Design) Progress Update Form 2017-18 *' • 6.11 (Trauma Center Data) Progress Update Form 2018-19 ** • 2018-19 Trauma System Plan ** • Alameda County EMS participates in the scheduled internal Trauma Center (TC) system and clinical oversight committee meetings (ALL CT's). This helps to ensure inclusive representation from the stakeholders involved with care of the trauma patient. • The Trauma Program Manager for Alameda County works closely with all TC program Managers and their facilities Trauma Process Improvement Coordinator to facilitate timely case closer regarding any EMS related clinical and or operational issues that ma im act atient outcomes. OBJECTIVE: LONG-RANGE PLAN: • Evaluate the need for an ACS EMS System Consultation 6.11 Trauma 3 3 Refer to previous sections and plans: The local EMS Agency shall ensure that designated trauma Center Data 1.07 (Trauma Planning) Progress Update Form 2018-19 centers provide required data to the EMS agency, including • 1.26 (Trauma System Plan) Progress Update 2018-19 patient specific information that is required for quality assurance/quality improvement and system evaluation. • 5.01 (Assessment of Capabilities) Progress Update Form 2018-15 • 5.04 (Specialty Care Facilities) Progress Update Form 2018-19 *" OBJECTIVE: (LONG-RANGE) • 6.10 (Specialty System Design) Progress Update Form 2017-18 * * Ensure appropriate feedback and action taken if /when • 6.11 (Trauma Center Data) Progress Update Form 2018-19 ** trauma patients are transported to non-trauma center • 2018-19 Trauma System Plan *" hospitals. Provide education on pediatric trauma. . Continued enhancement of quality improvement ---------- programs including those associated with trauma PROGRESS TO DATE: specialty care systems Trauma Centers -Contracts with Data Requirements • Continue to collaborate with system stakeholders in • The 3 Trauma Center -Master Contracts with Alameda Health System, Oakland review and revision of triage, treatment, transport and (previous Highland); UCSF Benioff Children's Hospital, Oakland, and Sutter Health transfer protocols regarding trauma patient care. Eden Medical Center (dba Eden Medical Center) scheduled for presentation to and Utilize TC specific as well as County and Region approval by the County Board of Supervisors provide for services through June 30, aggregated TQIP data to influence system change when 2021. needed. • In May 2016, Alameda County EMS facilitated the America College of Surgeons ~ACS1 "Trauma Consultation" survey at Alameda Health system -Highland Hospital. The completed consultation assisted in creating a roadmap of improvements. • In April 2017, the America College of Surgeons IAC51 "Trauma Consultation" reevaluated the three trauma hospitals and they continue to be verified centers of excellence in trauma care by the ACS. Alameda Health System -Highland is now designated a Level 1 trauma center. ACS CERTIFICATION requirement of current MOU. New MOU's completed in 2015. • Alameda Health System -Highland Hospital had a consultation visit for Level 1 status in May 2016. Alameda Health System -Highland Hospital had a successful Verification visit for Level 1 status in April 2017. • All trauma centers successfully completed their scheduled ACS Re-verification visits in 2017: Alameda Health System, Oakland (Highland)-Level 1 Adult; UCSF Benioff Children's Hospital Oakland -Level 1 Pediatric and Sutter Health Eden Medical Center-Level 2 Adult. • Continue to participate in and host the RTCC. CLINICAL SYSTEMS OF CARE -SPECIALTY CENTERS TRAUMA CENTERS: Page 99 ~ E j w cE N ~ ~ N R `o 01 N ~?' t`a z a ~ ~ ~ ~ ~ p~ ~ Progress - 2018 Objective - 2018-19 R N W = y ,~ •~ m~ ~ a> i pf ~ p~ UPDATED 9/18/19 ~ ~ ~' a~ y o J E • Monitoring of current contracts and data requirements. Take part in quarterly Trauma Audit Committee meetings. Implementation of the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP~). STROKE CENTERS • Monitoring of current contracts and data requirements. Lead the Alameda County Stroke Meeting three times a year. Developed a plan to streamline data flow utilizing Get with the Guidelines Registry in 2018. STEMI/Cardiac Arrest Centers: • Monitoring of current contracts and data requirements. Lead the Alameda County STEMI/Cardiac Arrest Meeting three times a year. PEDIATRIC TRAUMA CASE STUDY REVIEWS • Education on Pediatric Trauma Assessment and Trauma Destination is on-going at EMS stakeholder meeting including the ED Receiving Hospital Meetings and the ED Pediatric Site Visits • EMS Medical Director and Quality Review Committee is monitoring data to improve outcomes. G. Public Information And Education -Universal Level: 7.01 public 3 3 ~ PROGRESS TO DATE: The local EMS agency shall promote the development and Information INFORMATION DISSEMINATION dissemination of information materials for the public that Materials Alameda County EMS continues to develop and disseminate county-wide EMS addresses: understanding of EMS system design and information materials at community events and training programs. (Refer to Alameda operation; proper access to the system; self-help (e. g., CPR, County EMS Web-Site and the Blog). first aid, etc.); patient and consumer rights as they relate to The Alameda County EMS website includes: the EMS system; health and safety habits as they relate to c Information about our Agency and our Agency's roles. the prevention and education of health risks in target areas; o Information about the Alameda County EMS System and its components. and appropriate utilization of emergency departments. o Resources for providers to establish/maintain certification or licensure. OBJECTIVES: o Information for the public and current providers to obtain training LONG RANGE o Information on our various clinical care systems To continue with public education, awareness and o Stop the Bleed Campaign Page (www.youstopthebleed.org) information programs, updating information on issues as o Emergency Preparedness and Response Resources they are identified through changes in laws, best o EMS for Children (Emergency School Guidelines and ED Pediatric Readiness practices, community meetings, and input from partner Site Visit Resources) agencies -Proposed programs:, first responder falls • Implemented pilot using reusable manikins instead of individual /disposable CPR referral programs, childhood safety and injury prevention kits. areas, falls prevention discussion groups by EMS SIPP) Continue supporting the 9"' grade CPR training effort using the reusable manikins. (IPP does not conduct safety checks) SHORT RANGE PUBLIC INFORMATION OFFICER TRAINING Train EMS Staff on Public Information O~cer roles. Refer to 2017 EMS S stem Plan 7.02 injury ~ ~ ~ PROGRESS TO DATE: The local EMS agency, in conjunction with other local health Control COMMUNITY AEDS —PAD PROGRAMS education programs, shall work to promote injury control and HEARTSAFE PROJECT preventive medicine. • The Alameda County Project HeartSAFE became a reality in 2012. The project placed OBJECTIVES: • Based upon quantitative and qualitative data, continue 185 AEDs in County and community buildings. To accomplish the aggressive plan, outreach to low-income, racially/ethnically diverse Alameda County EMS partnered with Ice Safety Solutions of Fremont for the site populations. assessments, set-up and installation of the AEDs, CPR/AED training/recertification, Educate and advocate for the creation of appropriate and data management in a five year plan. legislation improving services for and safety of children and older adults Page 100 ~° d m °' O1R Q £ E d •_ ~ C 16 `o T ~ z g ~ ~ d ~ ~ ~ ~ Progress — 2018 Objective — 2018-19 {0 W 3 N ~ 'C a> pf w UPDATED 9/18/19 N ~ a~ ~ ~ y n~i o j ~' 0 ~ • ALCO EMS has collaborated with Alameda County Risk Management which intends Engage in community partnerships facilitating to fund maintenance of the Project HeartSAFE AED's located in County owned and intervention and more comprehensive service delivery to leased facilities for the next several years. at-risk populations to include Children, seniors, and Alameda County EMS intends to continue the HeartSAFE project at ninety three Functional Needs; connect case managers and mental community Board of Supervisor sites for three years. The project will include maintenance health teams). of AEDs at each community location. Work with other public and private agencies on Children CPR 9 and Older Adult Injury Prevention concerns • Continue collaborations with-public and private agencies • In 2017-18, Alameda County EMS implemented a pilot project using reusable on Children and Older Adult Injury Prevention concerns manikins instead of individual/disposable CPR kits. EMS is moving toward SHORT RANGE supporting the 9"' grade CPR training effort using the reusable manikins. Future Iniury Prevention training classes and annual plans will continue to support the 9th grade CPR training effort using the reusable conferences manikins. LONG RANGE HEART SCREENING Community Paramedicine Project • Twice in the past three years, Alameda County EMS has partnered with the Via • Develop and consider supplemental funding for Heart Project (Non-for profit) as a Co-sponsor for a one day heart screening for Community Paramedicine Program children 12-25 years of age. This service is FREE of charge to the community as LONG-RANGE PLAN: main sponsorship is secured by Via prior to the event. The Heart Screening Coordinate with Youth Alive and our three Trauma experience includes: Centers to develop new collaborative strategies to o Medical history, patient and family increase referrals for violence intervention services. o Height, weight and blood pressure o CPR and AED training 0 12-lead ECG and ECHO o Face-to-Face Physician consult STOP THE BLEED CAMPAIGN • Developed Stop the Bleed public awareness and information campaign for 2018 • Continued work with CBOs who provide services for older adults to identify older adult patients from 911 system who may benefit from fall prevention programs ALAMEDA COUNTY CARE CONNECT • Continued work with community partners to develop planning to connect high utilizers of 911 and other medical services with appropriate care (A~ • Worked with Intellectual and Develoomentai Disability Forensic Team (IDDFT) to develop goals for 2018 using Sequential Intercept technique ASSESS AND REFER • Another alternative for selected 911 patients who have been evaluated by a paramedic. Work group has been meeting. • Completion of a survey of Alameda County Paramedics about the acceptability and issues with this policy was completed and collated. • Further work planned on operational and training aspects of this policy. • Clinics have been invited to participate in the project. CHILDHOOD INJURY PREVENTIQN PROGRAM ALAMEDA COUNTY SAFE KIDS COALITION: • Facilitated by Injury Prevention Program (IPP) staff, Coalition focuses on prevention of unintentional injuries to children/youth; Coalition members include: East Oakland Health Center, Brighter Beginnings, Alameda Health Systems (Highland Hospital), Eden-Sutter Hospital, Oakland Police De artment, California Hi hwa Patrol, UCSF Benioff Children's' Hos ital Oakland, Page 101 ~ ~ y ~ ~ m m ~ ~ d `m R Q~ ~ E R `o R T ~ g ~ ~ ~ ~ p~ ~ Progress — 2078 Objective — 2018-19 ~p W = _ '~ a~ p~ ~ UPDATED 9!18/19 N S ~ m Q ~ C a~ p m ~ N o J ~ Asian Health Services, Alameda County Lead Program, Safe Routes to School, and numerous non-profit and community based organizations The Coalition meets monthly to share expertise, invite guest speakers and coordinated/ participated in 17 car seat check-up events and inspection stations, 7 health fairs and the following annual events i.e., Safe Kids International Walk to School Day (October) and World's Largest Swimming Lesson (June) and Safe Kids Day (April); • Injury Prevention Program (IPP) with assistance of other EMS staff and designated partners annually coordinates the EMS Week Kids Day event held in May 2016, 2017, and 2018. CHILD PASSENGER SAFETY Conducted 20 Child Passenger Safety Check-Up Events/Inspections Stations. • Provided education to 898 individuals • Distributed 320 child safety seats to low-income families • Provided installation assistance for 515 child safety seats • Provided MOU holding partners with an additional 220 child safety seats for distribution to their clients SAFE KIDS DAY Held 4"' annual Safe Kids Day in partnership with Supervisor Scott Haggerty • Distributed and properly installed 500 booster seats • Distributed and properly fit 500 wheeled sports helmets • Hosted community safety fair with 30 agencies/activities participating • 1,500 attendance CHILD PASSENGER SAFETY TRAININGS BASICS COURSE (CSPT) • Created Child Passenger Safety Basics 8 hour training for RNs, which was approved for 6 BRN CEs. Curriculum was reported on in Safe Ride News and the CA VOSP newsletter. • Safe Kids Worldwide is hosting the curriculum on their member resource website, and the AAP is currently undergoing a review. • With the support of certified instructors, IPP hosted and facilitated Child Passenger Safety Technician (CPST) classes in September 2015, April 2016; 2017. • Facilitated I hosted one Education Classes in October 2015, 2016, and 2917. EVERY 15 MINUTE PROGRAM. • Assisted Highland Hospital, part of the Alameda Health System, in the planning and coordination of their Every 15 Minute Program. • In May 2015, 2016, and 2017 collaborate with Alameda Health Systems, Eden- Sutter Hospital and local law enforcement. EMS WEEK • Hosted EMS Week Kids Day, May 2017 ~ Mav 24, 201 S. • 2017- 50 attendees, 2018- 75 attendees • Education and activities provided over a wide variety of topics, i.e. earthquake preparedness/safety, water safety, wheeled sports safety, fire prevention, etc. SWIMMING POOL EVENT • June 21.2018- hosting World's Largest Swimming Lesson event at Mills College Aquatic Facility. Will be providing 40 youth with free swim and CPR lessons. WALK TO SCHOOL DAY • Hosted International Walk to School Day event- 325 participants Page 102 9 a+ 41 ~ ~ ~ ~ ~ N ~ ~ C ~ d f0 = !0~ R Q ~ ~ ~ G1 'c E ~ m R o ~ ~ 7+ lC oC ~ Progress - 2018 Objective - 2018-19 N W ~ y = m 'C a~ pf r p ~' UPDATED 9/18/19 ~ ~ ~ y u~i 0 0 J ~ YOUTH ALIVE TRAUMA VIOLENCE INTERVENTION PROGRAM: • YOUTH ALIVE Caught in the Crossfire Trauma Violence Intervention Program contract renewed. Provides support to those physically injured by violent crime and treated at trauma centers including intervention to prevent retaliatory violence. BIKE/HELMET SAFETY PRESENTATIONS: • IPP staff provided helmet fittings and distribution at numerous community health fairs. GRANTS: • AAA awarded IPP 350 car seats in 2016 and 2017 for distribution to IPP community partners. • Safe Kids World V~lde: Local coalition established in the early 1990's; organization routinely provides printed educational materials; updates on best practices, policies and laws; grants and technical assistance. Refer to grant descriptions in table below. NEXT PAGE Page 103 d9 ~ E m z~ ~ C T ~ m ~ m ~ OTC ~ Progress — 2018 UPDATED 9/18/19 Objective — 2018-19 1=p W 7 ~ ~ a~ pl ~ H ~ ~~ y ~ o j o ~ Medicine Source: Safe Kids Worldwide with the support of Johnson 8 Johnson Consumer, Inc. Safety Purpose: To educate parents and caregivers of young children about responsible storage, dosing and Education Grant March disposal of medicine. Raise awareness and influence changes in knowledge by promoting key messages in the media and partner organizations. Goal: Conduct educational sessions with the goal of - Dec, 2018 reachin at least 100 individuals and to host at least one communi event. Bike to Purpose: To teach safe behaviors to kids and properly fit bicycle helmets. School Day Goal: Partner with local stakeholders and volunteers to hold at least one Bike to School Day event Grant -May where coalition members and volunteers chaperon children to school either by foot or bike and host 2018 educational activities. Water Safety Purpose: Educate families on how to protect children from preventable injuries in and around the Grant water. Raise public awareness to influence changes in knowledge and behavior by promoting key May —August messages in the community, in the media and through partner organizations. 2018 Goal: Conduct educational sessions with the goal of reaching at least 200 individuals and to host at least two interactive community events that focus on water safety and include content on safe pool environments — in the communi , as well as discuss sate around o n bodies of water. AAA Child Source: AAA Northern Cal'rfomia, Nevada &Utah Passenger Purpose: To provide car seats and booster seats to nonprofits and community groups that have Safety Seat established child passenger safety programs and provide free car seat inspections to their Donation communities. Feb: Dec. Goal: To distribute car seats and booster seats to families in-need at no charge. The goal is to have 2017 82018 the child arrive safer than how the artived to the fittin station or car seat checku event. Safe Kids Source: Eden Medical Center Day -Bike Purpose: This donation is spec~cally for Safe Kids Day, June 23 Helmets Goal: To distribute 500 free bicycle helmets and ensure proper fit to the children receiving them at the 2017 & 2018 time of donation. Safe Kids Source: AAA Northern California, Nevada 6 Utah Day Booster Purpose: This donation is specificalty for Safe Kids Day, June 23 Seats Goal: To distribute 500 free booster seats to families in-need. The booster seats will be property fitted 2017 8 2018 children receivin them and the families and care fivers will receive education on ro ruse. SAFE KIDS Source: Safe Kids Worldwide DAY Purposelgoal: Materials grant to support Safe Kids Alameda County's annual Safe Kids Day 2017 8 2018 'Ask the Source: Safe Kids Worldwide and Babies 'R Us —Purpose: Provide materials and funding to offer Expert' stipends for area Child Passenger Safety Technicians to host'Ask the Expert' car seat safety educational sessions at local Babies'R Us Stores Falls Goal: Provide education to parents on proper selection and installation of their child safety seats. Sua Prevention award agreement with the Partners in Care Foundation under their AOA Evidence-Based Falls Grant Prevention State Grant from Department of Health and Human Services, Administration for Community AUGUST 2, Living called 'Building along-Term Falls Prevention Network for Cal'rfomia's Elders (BALANCE). — 2017-JULY Purpose: Spread adoption of three evidence-based falls prevention programs; strengthen outcomes 31, 2020 data collection, and coordinate coalition efforts to build artnershi s. NEXT PAGE SENIOR INJURY PREVENTION PROGRAM (SIPP) • Senior Injury Prevention Partnership: Facilitated by IPP staff, Partnership focuses on prevention of unintentional injuries to seniors, age 60 plus. • SIPP Partnership includes: Alameda County Area Agency on Aging, Vital Link, United Seniors Oakland-Alameda County, Alameda Health Systems, Eden-Sutter Hospital, Spectrum, Senior Support Services of the Tri-Valley, Sutter Health Systems; City of Fremont, St. Mary's Health Center, Life Elder Care and other community based and non-profit organizations. • In addition to their networking and advocacy, SIPP plans and facilitates an annual statewide Senior Injury Prevention Forum. In its 17"' year, the 2017 forum will take place on June 2017.in Oakland, CA. SENIOR INJURY PREVENTION CONFERENCE 2018 • Hosted the 2018 SIPP Forum on March 16 at the Watertront Hotel in Oakland. Page 104 C N ~ N ~ N ~ f6 R Q~ ~~ R O 1p T ~ ~ ` ~ ~, ~ ~ p~ ~ Progress - 2018 Objective - 2018-19 R W ~ y ~ ~+ ~ p~ r,~ UPDATED 9/18/19 N P c+ a ~ a~ p o ~ ~ ~ N V J E • Launched 4 Matter of Balance workshops. • Serve as hosting agency for a Matter of Balance Master Trainer class on behalf of the Partners in Care Foundation. • Complete a site visit with the Partners in Care Foundation. • Hold a Matter of Balance Refresher Class for current coaches. STOP THE BLEED TRAINING -SENIORS • Conducted a Stop the Bleed training session at the Senior Injury Prevention Partnership Education Forum, with 100 of the 140 attendees being trained, including County Supervisor Nate Miley. SENIORS -GRANT • SIPP was awarded a 3 year grant from the Partners in Care Foundation to implement several fall prevention programs. • This work take place in partnership with two senior service providers. • Matter of Balance Fall Prevention Team supported a Contra Costa County Coach Training in August. The support will be reciprocated in the future. • SIPP helped plan and execute the Healthy Living Festival at the Oakland Zoo. • With 19 students from Northern Lights Middle School, SIPP provided some of the workforce for the serving of lunch to 2,000 seniors attending the Festival. Helmet Education Presentation CHILDREN Fall Prevention Presentation s SENIORS Emergency Preparedness Prezi's SENIORS Age Well Drive Smart Prezi's SENIORS Senior Health Fair Total Presentations- 4 Total Total Total 2 Total Health Fare's: 2 Participants: 352 Presentations: Presentations: 9 Partici- Participants: 350 - 1—Presentation for 300 17 Participants; pants; 63 went to booth for both (Envision Students @ Participants; 225 events and received UC Berkeley) 308 materials 2- HelmeUcar seat Safety Healthy Living Festival Presentation at Oakland and Satellite Head Start 22 parents Affordable Housing 1-Rec Center Associates: SARA 30 Elementary school Senior Health Fair a e kids EDUCATIONAL PRESENTATIONS: IPP staff conducts the following sessions: FALLS PREVENTION DISCUSSION GROUPS: • 22 presentations with residents and 5 sessions with nursing students/health/social service professionals. EMERGENCY PREPAREDNESS: • Conducted quarterly in response to outreach to programs serving seniors. HEALTH FAIRS: • Annually participate in planning and participate in the Healthy Living Festival sponsored by Alameda County Board of Supervisor Nate Miley. Plus participated at seven (7) community based fairs primarily between April and October for a total of 7 fairs. ADVOCACY: IPP Staff serves on Alameda County Medication Coalition EMS WEEK• Page 105 C y ~ ., d y w d `m R Q~ c E R o ~ ~ g ~ ~ m ~ ~ p~ ~ Progress — 2018 Objec4ive — 2018-19 ~p W 3 ~ a> p~ ~ UPDATED 9/18/19 H P~ m ~ ~ ~ a~ N p ~' o ~ ~ Q J ~ • Annually, host the May meeting of the Alameda County Round Table. Member organizations serve seniors. GRANTS• • California Department of Public Health for the second year awarded IPP funds to implement two evidenced based programs—Stepping On and Tai Chi. Stepping On consists of 8 week sessions and Tai Chi consists of 12 week sessions held throughout the year. • Partners In Care Foundation (PIC) in September 2015 awarded IPP a two-year grant to implement Matter of Balance (MOB) and STEADI, two evidenced based programs. • Successfully fulfilled terms of year 1 grant with PIC by training 30 coaches completing 64 Matter of Balance (MOB) classes. Initiated year two by training 15 coaches and scheduled MOB classes throughout the county. Measure A funds community based falls prevention and medication management programs. ALAMEDA COUNTY HEALTH COACH PROGRAM • With the support of the Robert Wood Johnson Foundation's Workforce Development Program, young adults with a passion for health education will work with patients at Alameda Health System-Highland Hospital. This innovative program is the first to provide health coaching directly from the Emergency Department. PIPELINE PROJECT • The Pipeline Partnership with collaborate with Berkeley Youth Alternatives (BYA) to build more health care internship positions for youth in Alameda County. BYA will act as fiscal agent to oversee grants awarded to expose youth to hands-on- internship activities in the health industry 2018 and 2019 NEW CHANGES/HEALTH CARE SYSTEM AND POLICY -SENIORS • Evidenced Based Programs for Seniors—funding from California Department of Public Health and Partners In Care Foundation allowed IPP to introduce evidenced programs to Alameda County programs i.e. Stepping On, Tai Chi, Matter of Balance and STEADI. -Safe Kids Worldwide: Eliminated the provision of insurance coverage for registered Safe Kids Car Seat Check-Up events. This change resulted in partner organizations assuming responsibility for the provision of insurance. FALL PREVENTION • Education Forum May 2016 and Train-the Trainer August 2015-July 2017 COMMUNITY PARAMEDICINE • Continued partnership with Alameda Fire to implement of this OSPHD-directed pilot study. Continued work to help explore funding options through November of 2019 (the end of the study) • Collect data from the program (frequent 911 users and recently discharged patients in the city of Alameda) and report to UCSF who aggregates and analyzes data for EMSA. Participate is steering committee meetings to discuss client outcomes, community paramedic practices, and program possibilities for the future CHILD CARE EMERGENCY PLAN'~TRAIN THE TRAINER" • EMS for Children Coordinator designed, developed, and disseminated curriculum to Alameda and Contfa Costa County Safety and Injury Prevention Committees. LAW ENFORCEMENT PROGRAMS —OPIATE OVERDOSES Page 106 C ~ w £ N ~ ~ d t6 = TR Q~ d._ ~ R o ~ _ ~ i ~ m ~ ~ ~ ~ Progress - 2018 Objective - 2018-19 R W ~ N ~ ~ a> O1 ~ UPDATED 9/18/19 N ~ d ~ ~ y ~ o p ~' 0 J E • Approved Law Enforcement Programs to provide naloxone (Narcan) for suspected opiate overdoses in Alameda County are: o Alameda County Sherriff's Office o East Bay Parks Police Department o Fremont Police Department o Hayward Police Department o Newark Police Department o Oakland Police Department o Pleasanton Police Department o Union City Police Department o San Leandro Police Department o Livermore Police Department 7.03 Disaster 3 PROGRESS TO DATE: The local EMS agency, in conjunction with the local office of Preparedness MEDICAL SURGE PROJECTS AND DPHC emergency services, shall promote citizen disaster • EMS Surge Plan 2019 preparedness activities. • HPP 2018-19 Workplan. Available upon request from HPP LEMSA Coordinator. OBJECTIVE • HCC- With the Disaster preparedness Health Coalition (DPHC), partners are MEDICAL SURGE leveraged to clarify disaster /surge response roles for an all-hazard and event The priority EMS benchmark is to strengthen medical specific scenarios. surge capability and capacity in a disaster. The focus is ALAMEDA COUNTY MHOAC MANUAL to clarify the health care system response for a surge of • Although Alameda County currently has the OA Emergency Operations Plan as well Patients that exceed health care system existing as EMS specific MCI, medical surge, and disaster medical operations plans, resources. The goal is to strengthen the plan for medical surge Alameda County EMS is reviewing and updating the MHOAC Manual Guide patient tracking and patient movement to ensure The final MHOAC Manual with the Incident Response Guides will be finalized in effective adult and pediatric response in 2018-2019. 2019-20. The MHOAC Manual identifies roles and activities for the Health Care Services agency are identified including EMS, PH, BH, and EH. Hospital coordination functions are included. STATEWIDE MEDICAL/HEALTH FUNCTIONAL EXERCISE • Alameda County EMS conducted the functional exercise November 2018. Communications, and EOC Coordination capabilities were tested with county-wide partners including Paramedics Plus, hospitals, SNFs, clinics, and Alameda County OES COALTION SURGE TEST (CST► EXERCISE— FOCUS HOSPITAL EVACUATION • Alameda County EMS held the first CST "Dry Run" and Test June 14, 2018 and June 27, 2018. The CST was also held May 30, 2019. The EMS Branch DOC was activated to coordinate and identify patient movement resources available for evacuating hospitals who needed to transport patients to receiving hospitals. YELLOW COMMAND —URBAN SHIELD CATASTROPHIC EARTHQUAKE FUNCTIONAL EXERCISE • Alameda County activated the OA EOC Medical/Health Branch 9/6/18 URBAN SHIELD TRAINING —PARTNERSHIP WITH ALAMEDA COUNTY OES • Held Urban Shield Mass Casualty Incident full scale exercise 9/2018. Urban Shied has been defunded by BOS actions. EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Project • Exercise Scoae: Two linked exercises (Tabletop and Full Scale) tested the models for side-by-side coordinated in-the-field victim stabilization between Emergency Medical Services EMS units and Communit Health Centers CHC . Page 107 C y m y d) (6 R ~ w ~ ~ R T _ Q~ ~ ~ c~ ~ R o ~ ~ ~ ~ Progress — 2018 UPDATED 9/18/19 Objective — 2018-19 R W 3 ~ a~ p~ ~ N d a~ a~i ,t ~ p ` ~ ~ ~ N a J ~ • Models were developed with coordinators from Alameda County EMS and Community Health Centers of the Alameda Health Consortium through an independent consultant Barbara Morita. • Full-scale exercise conducted MaV 30 and 31, 2018 at three clinic locations. • Hospitals supported this new model pilot project TRAIN —TRIAGE RESOURCE ALLOCATION FOR INPATIENT (EVACUATION) • Promoting the Triage by Resource Allocation for In-patients (TRAIN) project in 2017- 19. Supporting Sutter Hospital TRAIN implementation project in Alameda County • Alta Bates Summit Berkeley and UCSF Children's Hospital participated in the TRAIN Exercise held June 25, 2018. • The next NICU TRAIN and surge planning meeting will be held July 17, 2018 in Alameda County. DISASTER /SURGE TRAINING MHOCSA TRAINING • RDMHS developed and conducted CST( Medical Health Operations Center Support Activities (MHOCSA) Courses in May 2018 and 2019 EOM TRAINING • Conducted several Emergency Operations Manual (EOM) training classes. Hospitals participated in the training. MCI DEPLOYMENT MODULES 8 RESOURCES • EMS submitted several grants via Urban Areas Security Initiative (UASI) for terrorism related program funding. • EMS participates on the UASI training/exercise committee and also on the senior approval board. Six MCI Deployment Modules were purchased in June 2018 for use in a mass casualty event. MCI deployment caches have been transferred over to Falck. Clinics will receive Point of wounding kits once they receive just in time training. REDDINET COMMUNICATIONS • Alameda County EMS is conducting ongoing training and exercises with ReddiNet focused on patient tracking and customized assessment polling with emphasis on hospitals, SNFs, clinics, prehospital fired department ALS transport, 911 and Non- 911 Permitted Ambulance Providers, Alameda County OES and the City of Oakland OES. • The ReddiNet Coordinator is Cynthia Frankel, RN - PHCC at Alameda County EMS REGIONAL DISASTER MEDICAL HEALTH SPECIALIST (RDMHS~ POSITION • On December 4, 2012, the Board accepted atwo-year agreement between the Alameda County EMS and CA EMSA to provide regional disaster medical health coordination services for the period July 1, 2012 through June 30, 2014. An updated agreement was executed in 2015 and in 2016 providing for the continuation of services through June 30, 2017. An extension agreement governing services through June 30, 2018 occurred. The RDMHS position is the component of the Regional Disaster Medical and Health Coordination Program that directly supports regional disaster preparedness, response, mitigation, and recovery activities. • Travis Kusman is the new Region II RDMHC as of August 201 S at San Mateo EMS. Aram Bronston is the new RDMHS REGIONAL DISASTER MEDICAL HEALTH SPECIALIST PROGRAM • The RDMHS manages the program which includes but is not limited to: 24/7 res onse to Re ion II emer encies; emer enc mutual aid coordination for medical Page 108 C y ~ a.. y ~ ~ d) f6 R Q E '~ ~ R o !C 'a R ~ ~ ~ ~ @ ~ ~ Progress - 2018 Objective - 2018-19 W 7 y ~ ~ ~ CI ~ UPDATED 9/18/19 N ~ m ~ y ~ j ~' 0 ~ o ~ and health including processing situation reports and resource requests from the Region II Operational Areas; participates in Urban Shield. and organizes the Ambulance Strike Team mass casualty scenario. • The RDMHS also leads the regional Ebola and Infectious Disease Transportation project. RDMHS Region II coordinated and attended an EMS/Ebola unit training offered in conjunction with Kaiser Permanente Oakland and served on the work groups for several different statewide plans including the Statewide Patient Movement Plan and the Emergency Operations Manual revision. • Conducted Ambulance Strike Team exercise as part of Urban Shield September 2018 in Alameda County. Conducted Ambulance Strike Team Leader class trainings in October 2018. • Participated in 2018 and 2019 upcoming statewide medical/health exercises. PORT OF OAKLAND EXERCISE 2018 • Participated in large (FBI, OPD, OFD, ACSO, EMS, Port of Oakland) exercise named "Operation Seasickness" simulating a terrorist attack on a vessel with many contaminated victims. • "Transported" several victims to Highland Hospital, who participated as well. CALIFORNIA PEDIATRIC SURGE PROJECT • Cynthia Frankel, EMS for Children and HPP EMSA Coordinator lead on the development of the draft framework. Components adapted to the Alameda County Pediatric Surge Plan. • The CDPH/EMSA Pediatric Surge CONOPs to support the CA Patient Movement Plan is being developed by the CDPH/EMSA Pediatric Surge Committee. Cynthia Frankel is participating on the committee and ASPR pediatric surge project. CHILD CARE EMERGENCY PLAN "TRAIN THE TRAINER" • EMS for Children Coordinator designed, developed, and disseminated curriculum to • Alameda and Contra Costa County Safety and Injury Prevention Committees. • EMS submitted several grants via Urban Areas Security Initiative (UASI) for terrorism related program funding. EMS participates on the UASI training/exercise committee and also on the senior approval board. 7.04 First Aid& 3 ~ PROGRESS TO DATE: The%ca/EMSagenry shall promote the availabilityoffrr_staid CPR AED/PAD PROGRAM and CPR training for the generalpub/ic. Training HEARTSAFE PROJECT • The Alameda County Project HeartSAFE became a reality in 2012. The project OBJECTIVE: placed 185 AEDs in County and community buildings. To accomplish the aggressive AED/PAD PROGRAM - HEARTSAFE PROJECT • With a need to increase Sudden Cardiac Arrest (SCA) plan, Alameda County EMS partnered with Ice Safety Solutions of Fremont for the site assessments, set-up and installation of the AEDs, CPR/AED survival rates in Alameda County, the HeartSAFE training/recertification, and data management in a five year plan. Project goal was envisioned to provide 185 AEDs with ALCO EMS has collaborated with Alameda County Risk Management which intends training, oversight, and maintenance in high risk /high traffic locations. to fund maintenance of the Project HeartSAFE AED's located in County owned and Alameda County EMS ensures this project remains leased facilities for the next several years. Alameda County EMS continues the HeartSAFE project at ninety three community Board sustainable and campaigns to promote community of Supervisor sites for three years. The project includes maintenance of AEDs at each AEDs with the message: PUBLIC SAFETY FIRST AID PROGRAMS —NEW community location. Implement credentialing program as required by state CPR 9 regulation for Public Safety First Aid programs in 2017. Page 109 `m ~ ~ ~ r E m N ~ ~ m f0 Q E R ems, 9 ~ ~ ~ m ~ ~ oG ~ Progress — 2078 06jective — 2018-19 1=7 W 3 3 ~ d Of ~ UPDATED 9/18/19 N ~ ~ ~ y ~ j o E • Alameda County EMS implemented a pilot project using reusable manikins instead CPR 9 of individual/disposable CPR kits. EMS is moving toward supporting the 9"' grade Collect data from survey forms to determine the CPR training effort using the reusable manikins. Future plans will continue to multiplier effect of the CPR7 project to increase the support the 9th grade CPR training effort using the reusable manikins. number of citizens trained in providing chest • Program developed for public school 7th graders in Alameda County. compressions to people who have suffered cardiac • Implemented pilot using reusable manikins instead of individual /disposable CPR arrest kits. Continue supporting the 9"' grade CPR training effort using the reusable Increase the number of citizens trained in providing manikins. chest compressions to people who have suffered cardiac arrest HEART SCREENING Increase access to AEDs with trained emergency • Twice in the past three years, Alameda County EMS has partnered with the Via response teams Heart Project (Non-for profit) as a Co-sponsor for a one day heart screening for LONG-RANGE: children 12-25 years of age. This service is FREE of charge to the community as Support CPR 9 in a multi-year project. main sponsorship is secured by Via prior to the event. • Continue HeartSAFE Project PUBLIC SAFETY FIRST AID PROGRAMS • Implemented credentialing program as required by state regulation for Public Safety First Aid ro rams in 2017. H. Disaster Medical Response -Universal Level: $•~~ Disaster 3 ~ PROGRESS TO DATE: In coordination with the local office ofemergencyservices Medical ALAMEDA COUNTY EOC MEDICAL/ HEALTH BRANCH Planning* —OPTIMIZE FUNCTIONALITY (OES), the%ca/EMS agencysha//participate in the OPERATIONAL AREA EOC deve%pment ofinedical response plans for catastrophic • ALCO EMS collaborated with the Sheriffs Department Office of Emergency Services disasters, inc/uding those invo/ving toxic substances. and Homeland Security to upgrade the operational area EOC Medical/Health Branch OBJECTIVES: LONG-RANGE PLAN with improved physical space functionality and technology assets. Overarching Goals: MOBILE OFF-SITE OPERATIONAL CAPABILITY To strengthen system-wide MCl/disaster/surge capability • EMS Director, EMS Deputy Director and EMS Coordinators including the MHOAC and capacity; ensure robust planning, training and risk and RDMHS have new mobile laptops with extended life batteries and enhanced mitigation connectivity to ensure operational self-sufficiency, reliable communications and To ensure the coordination of acute care patients among information management capability. All also have issued 700/800Mhz EBRCSA county health care facilities and other health care portable radios for emergency communications. The EMS Director, EMS Deputy partners. (consistent with CA Medical/Health EOM) Director, MHOAC and RDMHS also have issued satellite voice and data DISASTER PREPAREDNESS HEALTH COALITION communications devices. To integrate and leverage medical health system HPP PROGRAM —DISASTER GRANT PROJECT ~ stakeholders and partners into preparedness planning HPP ADMINISTRATIVE CHANGES efforts • The administration of the Hospital Preparedness Program (HPP) grant continues To integrate and collaborate with medical/health system-underthe Alameda County Public Health Department. The HPP LEMSA Coordinator wide partners to leverage effective disaster response Cynthia Frankel continues to coordinates the HPP workplan deliverables with the plans HPP Coordinator in Public Health. Maximize partnership with Alameda County Health Care o ALCO EMS staff support activities of the HPP workplan (such as the 700/800 Services Agency Divisions -Behavioral Health Care and megahertz Radios programs and the annual statewide exercise). Cynthia Environmental Health. Frankel Is the co-project lead for the statewide exercises in 2018 and 2019. o ReddiNet coordination facilitated by Cynthia Frankel, ReddiNet Coordinator, PANS AND POLICIES remains essential program component To strengthen already existing plans with focus on DISASTER PREPAREDNESS HEALTH COALITION /DPHCI medical surge —aligning with state and regional plans and uidance Page 110 E C y •~~ ~ y R ~ a g ~ ~ ~ Ro ~ ~ ,s~ pC ~ Progress — 2018 Objective — 2018-79 16 N W p ~ y '3 ~ ~ ~ pf w J o UPDATED 9/18/19 ~~ y o E • The EMS HPP EMS Coordinator —Cynthia Frankel, RN, continues to support the To develop an operational county wide MHOAC Manual HCC Coalition - DPHC Steering Committee and Workgroups to leverage system- with the Incident Response Guides and supporting wide partners and to facilitate effective planning and exercises. EMS Director and annexes (ie. Medical Surge Expansion Framework and EMS Coordinators support the DPHC as needed. Pediatric Medical Surge Plan) • Regional Disaster Medical /Health Specialist resides within Alameda County EMS EXERCISES and provides on-going state/ regional updates, training and planning activities for Coordinate plans, test plans in exercises, and prepare HCC Coalition - DPHC. HSEEP compliant after action reports with corrective 2018-19 HPP WORKPLAN action plans. • Development and implementation of 2017-18 workplan; prepared 2018-19 workplan Conduct exercises with focus on health care facility, first HPP EMSA COORDINATOR MOU —ALAMEDA COUNTY EMS responder, BLS and ALS integration. • Subcontract Health Care Services Agency for HPP Deliverables COMMUNICATIONS AND INFORMATION Management Strengthen emergency communications, and information MEDICAL SURGE PROJECTS • EMS Surge Plan management infrastructure. (ie. ReddiNet) • The priority EMS benchmark in the HPP deliverables is to strengthen medical surge MEDICAL SURGE (LONG-RANGE PLAN) capability and capacity in a disaster. The focus is to clarify the health care system —PATIENT TRACKING AND PATIENT MOVEMENT Enhance preparedness to respond to multiple casualty response for a surge of patients that exceeds the system's routinely available existing resources. The goal is to strengthen the plan for medical surge bed incidents given reality of Hybrid Targeted Violence, Active expansion/decompression, patient tracking, patient movement, and effective Shooters, terrorism, and multi-site coordinated attacks. pediatric response. Strengthen triage, patient tracking, and patient movement • In 2017-18, the focus is developing the Alameda County MHOAC Manual with functions while simplifying associated workflow for Incident Response Guides. The first draft was completed. The final manual with the IRGs will be completed in 2019-20. responders. MEDICAL SURGE PLAN Deploy Point of Wounding /Triage response packs • The CDPH Pediatric Surge Committee and EMS Workgroup are preparing a across system. CONOPs to the Patient Movement Plan. Although the pediatric surge plan-was Continue development of Tactical EMS and Rescue Task revised, additional revisions will occur consistent with EMS for Children Regulations Force programs. Continue to design and implement and the CDPH/EMSA Pediatric Medical Surge recommendations. Public Access Hemorrhage Control program. • The medical surge workgroup has been recreated to form separate committees: Enhance ReddiNet capabilities and facilitate training for o EMSC Pediatric Readiness, and Surge Advisory Committee with UCSF Benioff all EMS system partners Children's Hospital o Co-Location Project Planning Committee Strengthen Medical Surge Hospital Bed Expansion and o ReddiNet Planning Committee Pediatric Patient Movement Coordination Capability and process for a surge of patients o MCI Policy Planning Committee o Non-911 Permitted Ambulance Providers o Bay Area NICU Surge Planning Committee focused on the TRAIN Project • Alameda County EMS will continue to develop the hospital bed expansion / decompression framework for a surge of critical patients • Continue to lead (host) andlor participate in the State Regional and local Disaster Committees to include: o Regional: -Lead (host) Region 2 MHOAC Committee; participate on the Association of Bay Area Health Officers (ABAHo), and UASI Emergency Management and Medical Shelter Workgroup; and lead the Ebola and Infectious Disease Workgroup o State —Participate in the Patient Movement, California Medical /Health Emergency Operations Manual Committee and Workgroups; California Child Care Disaster Plan Committee {which now has ended); and CDPH / EMSA Pediatric Sur e and EMS Work rou . 8 02 Response 3 Refer to arevious sections and clans: Medical response plans and procedures for catastrophic Plans 3.06 (MCIIDisasters) Progress Update Form 2018-19 disasters shall be applicable to incidents caused by a variety of 4.12 (Disaster Response) Progress Update Form 2078-19 hazards, including toxic substances. Page 111 C £ N 3 ~.. d ~ ~ ~ 41 N ~ z y d g ~ d ~ ~ o~C ~ `m ~ ~ ~o Progress - 2018 Objective - 2018-79 R W ~ N •_ ~ a~ pf ~ UPDATED 9/18119 N ~ dd sa o~' ~ ~ ~ N v J ~ • 4.15 (MCI Plans) Progress Update Form 2018-19 • 5.05 (Specialty Care Facilities) Progress Update Form 2017-18 PROGRESS TO DATE: PLANS AND POLICIES • Alameda County Emergency Plans are multi-hazard functional plans consistent with the California Multi-Hazard Plans and the California Medical Health EOM. Alameda County aligns with above plans. Refer to alameda County response plans and policies below: • ALAMEDA COUNTY EMERGENCY OPERATIONS PLAN • MCI POLICY — 2020 EMS Field Manual implementation in progress • ALAMEDA COUNTY EMS Surge Plan 2019 • ALAMEDA COUNTY MEDICAL SURGE EXPANSION FRAMEWORK PEDIATRIC OBJECTIVE: The Alameda County EOP and California Medical/Health Emergency Operations Manual (EOM) serve as the primary plans to guide the planning and response in Alameda County MEDICAL SURGE PLAN • REDDINET ADMINISTRATION POLICY- Operations Plan • CENSUS REPORTING POLICY— Alameda County Operations Plan • EMS DUN OFFICER NOTIFICATION POLICY has been finalized, implemented by ACRECC. Implemented new policies and procedures by Alameda County Regional Emergency Communications Center to improve EMS system performance and notification of EMS Agency Duty O~cers • DISPATCH MCl/DISASTER NOTIFICATION POLICY: Development of new policies and procedures to be implemented by the contracted 911 dispatch provider to improve EMS resource allocation and ensure notification of key personnel in EMS administration of significant events in the system. • SPECIAL EVENTS POLICY —Alameda County EMS is in the process of developing and implementing a special events coverage policy. This policy will enable non- emergency permitted providers to handle on-site medical coverage at large events venues, ideally decreasing impact of activities there on the 911 system. The Alameda County MHOAC Manual developed in 2017-18 (adapted from the San Mateo template). The Alameda County DMOP will be replaced by the MHOAC Guide. Initiated customization of the new Alameda County Medical Health Operational Area Coordinator (MHOAC) Manual Incident Response Guides for Alameda County. Finalizing plan in 2019-20. EMERGENCY PREPAREDNESS AND RESPONSE RDMHS Region II • RDMHS Region II helped to conduct another Ambulance Strike Team Leader class as well as an EOM training session for regional stakeholders • RDMHS Region II completed duties as assigned by Alameda EMS agency, California EMS Authority Disaster Medical Services (EMSA DMS), and CDPH Emergency Preparedness Office. Maintained normal response activities in accordance with the CA Emergency Operations Manual and this Scope of Work. • Hosted quarterly MHOAC 2018 and 2019 with Bay Area OA attendance and participation. Continued collaboration and communications with OES regional partners. • Assigned by EMSA and CDPH leadership to participate in the Patient Movement Plan workgroup. Reviewed draft Patient. Movement Plan at the request of EMSA and the contractor and provided feedback as necessary. • Continued planning for State Wide Medical Heath Exercise (SWMHE) Exercise 2017 and 2018 with regional stakeholders. • Also artici ated in tannin for Urban Shield 2017 and u comin 2018. Page 112 +y-'~ V1 9R ~ Q ~ 7 ~ d ~c = ~ `o C ~ _ ~ ~ ~ ~ ~, RoC ~ {0 '-p~ ~ Progress — 2078 Objective — 2018-19 ~p W = ~ a~ p~ ~ UPDATED 9/18!19 ~ ~ ~ y ~ p o J ~ PORT OF OAKLAND EXERCISE 2018 • Participated in large (FBI, OPD, OFD, ACSO, EMS, Port of Oakland) exercise named "Operation Seasickness" simulating a terrorist attack on a vessel with many contaminated victims. • "Transported" several victims to Highland Hospital, who participated as well. DISASTER READINESS /EMERGENCY DISASTER DEPLOYMENTS NORTH BAY FIRES 2018 • EMS disaster preparedness staff including and in support of Regional Disaster Medical Health Specialist (RDMHS) Region 2. • EMS Branch activated to support Region II RDMHS WARRIORS PARADE -JUNE 2018 • EMS was involved in supporting the preparation for and coordination of medical response associated with the Warriors celebration in Oakland which was attended by in excess of a million people. EMS planned and prepared for the worst given recent terrorist activity world-wide. EMS coordinated with multiple ambulance providers, fire departments, local and federal law enforcement agencies, hospitals and EMS Agencies in neighboring counties, facilitating the delivery of highly efficient and effective emergency medical care. Refer to 8.02 in the 2018 EMS S stem Plan 8.03 HazMat 3 3 3 PROGRESS TO DATE: All EMS providers shall be properly trained and equipped for Training Refer to 8.03 in the 2017 Alameda County EMS System Plan response to hazardous materials incidents, as determined by • Nearly all public safety providers have received hazmat training in at least the "First their system role and responsibilities. Responder Assessment Level" TRAINING OBJECTIVE: HAZMAT training provided by employer " Conduct WMD training for providers (LONG RANGE) Alameda County EMS Plans the Urban Shield Medical Branch Section activities Purchase equipment for providers focused on WMD and leads the Annual Urban Shield Exercise. Medical Operations *' (Urban Shield (SHORT RANGE) Exercise held September 2018) PORT OF OAKLAND EXERCISE 2018 • Participated in large (FBI, OPD, OFD, ACSO, EMS, Port of Oakland) exercise named "Operation Seasickness" simulating a terrorist attack on a vessel with many contaminated victims. • "Transported" several victims to Highland Hospital, who participated as well. Special Operations Division —The Alameda County Fire Department Special Operations Division is responsible for training personnel and maintaining equipment to provide hazardous material and water rescue response capabilities. All City of Alameda firefighters are trained in hazardous materials to the First Responder Operations (FRO) level. The Alameda Fire Department works in conjunction with the Alameda County Fire Department HAZMAT Team. "'Refer to Alameda County EMS Field Manual 2019 for MCl/Disaster/WMD Section: Biological Attack; Chemical Attack; CHEMPACK Deployment; Decontamination Incident; Hazardous Materials, and other relevant policies. 8.04 Incident 3 Refer to Alameda County 2019 MCI Policy (Alameda County website - 2019 Medical response plans and procedures for catastrophic Command EMS Field Manual►, disasters shall use the Incident Command System (ICS) as the System 2020 MCI Policy implementation in progress. The Alameda County Emergency basis for field management. Operations Plan is available upon request. The Alameda County MHOAC Manual draft is available u on re uest. Page 113 ~ y ~ N GI to 9 d ~ ~ ~ ~ N _ = T ~ ~ vai d ~ ~ d ~ ~ ~ ~ Progress - 2018 Objective - 2018-19 ~ ~ ~ a`~i p~ ~ UPDATED 9/18/19 0 ~ o s 8.05 Distribution of Casualties` 3 3 Refer to previous sections and plans: 4.12 (Disaster Response) Progress Update Form 2018-19 4.15 (MCI Plans) Progress Update Form 2018-19 • MCI Policy (2019 EMS Field Manual) PROGRESS TO DATE: EBOLA AND INFECTIOUS DISEASETRANSPORTATION PROJECT: The local EMS agency, using state guidelines, shall establish written procedures for distributing disaster casualties to the medically most appropriate facilities in its service area. OBJECTIVE: LONG RANGE PLAN: Work with Region 2 to develop a surge mutual support plan • The RDMHS (located at Alameda County EMS) is managing the workplan for the HPP Supplemental Ebola funding for EMS transport. Collaborate with Region II MHOACs and ReddiNet • The RDMHS worked with the Region II MHOAC's to draft the Ebola transport Administration (HASC) to strengthen ReddiNet patient ConOps; and worked with the Alameda HCC to purchase Ebola/ID PPE and other tracking and operational effectiveness in a surge event. equipment. Adapt the Patient Movement Plan (pending at state MCI POLICY level) to Alameda County. • Per the Alameda Countv MCI Policv, hospitals are polled for MCI incidents involving Implement the Pediatric Surge Plan as needed 15+ patients via ReddiNet. Update Pediatric Surge Plan as needed pending the • For the duration of the MCI, the Transport Group Supervisor under ICS will EMSA/CDPH Pediatric Surge Planning Committee determine transportation methods and destinations and notify facilities of the number recommendations of incoming patients. Develop HCC Coalition Pediatric Surge Annex • MCI Policy was updated in 2017. Refer to 2018 Field Manual. MHOAC AND RDMHS • During a disaster and/or medical surge event, the MHOAC will coordinate medical response, share situation status and request mutual aid in conjunction with the RDMHS (per the above mentioned plans consistent with the CA Medical/Health EOM). The RDMHS completed the Critical Decision Making for Complex Coordinated Attacks. This course is pending availability in Alameda County for EMS and providers • Travis Kusman, EMS Director, is the Region II RDMHC. REDDINET COMMUNICATIONS -POLICY The Alameda County Regional Emergency Coordinating Center (ACRECC) will send a "bed capacity" poll via ReddiNet • ReddiNet will be utilized for HAVBED reporting and customized assessment polling. • Patients are tracked via ReddiNet Alameda County EMS is conducting ongoing training and exercises with ReddiNet focused on patient tracking and customized assessment polling with emphasis on hospitals, SNFs, clinics, prehospital fired department ALS transport. 911 and Non- 911 Permitted Ambulance Providers, Alameda County OES and the City of Oakland OES. • The ReddiNet Coordinator is Cynthia Frankel, RN - PHCC at Alameda County EMS COALITION SURGE TEST (CST) • The annual CST exercise was conducted May 30, 2019 The CST hospital evacuation exercise was conducted on June 27, 2018. The EMS Branch DOC was activated to coordinate and identify patient movement resources available for evacuating hospitals who needed to transport patients to receiving hos itals. 8.06 Needs 3 Refer to previous sections and plans• Alameda County EMS agency, uses state guidelines, shall Assessment 4.12 (Disaster Response) Progress Update Form 2018-19 establish written procedures for early assessment of needs • 4.15 (MCI Plans) Progress Update Form 2018-19 and shall establish a means for communicating emergency requests to the state and other jurisdictions. • ReddiNet Utilization Policy OBJECTIVES: Refer to Alameda Coun 2017 EMS S stem Plan — 8.05 Page 114 ~ `n R E 3 +~.' E °' R W ~' L a ~ ~ ~ d a ~ m p~ ~ Progress — 2018 Objective — 2018-19 R W 3 N ~ ~ a> p~ $ UPDATED 9/18/19 ~ ~ N o ~ ~ o J E PROGRESS TO DATE: Align and support pending updated California Medical / MCI POLICY Health Emergency Operations Manual (EOM). • Per the Alameda Countv MCI Policv, hospitals are polled for MCI incidents involving Finalize the Alameda County MHOAC Manual for 2018 15+ patients via ReddiNet. consistent with the EOM. • For the duration of the MCI, the Transport Group Supervisory under ICS will determine transportation methods and destinations and notify facilities of the number of incoming patients. • MCI policy updated/ modified and approved. REDDINET COMMUNICATIONS -POLICY • The Alameda County Regional Emergency Coordinating Center (ACRECC) will send a "bed capacity" poll via ReddiNet ReddiNet will be utilized for HAVBED reporting and customized assessment polling • Patients are tracked via ReddiNet • ReddiNet modules and permissions were updated in 2017-18 for Alameda County system-wide ReddiNet users. • ReddiNet reports are distributed to the Disaster Preparedness Health Coalition which provide utilization and activity in "real time." The ReddiNet Coordinator shares the reports after "real" events and exercises with recommendations for improvement. EMERGENCY /MEDICAL SURGE PLANS AND PROCEDURES The Alameda County EMS written policies and procedures for distributing patients are listed below: • MCI Poiicy — 2019 EMS Field Manual; 2020 update in progress • Alameda County Emergency Operations Plan • Alameda County Medical Surge Expansion Framework —Options for Critical Care Expansion • Pediatric Medical Surge Plan • ReddiNet Administration Policy- Operations Plan • Census Reporting —Alameda County Operations Plan • Alameda County MHOAC Manual pending final revision MHOAC AND RDMHS • During a disaster and/or medical surge event, the MHOAC will coordinate medical response, share situation status and request mutual aid in conjunction with the RDMHS (per the above mentioned plans consistent with the CA Medical/Health EOM). • The Alameda County MHOAC Manual first draft was developed (adapted from the San Mateo Template) in 2017-18. • Assessing resource tracking coordination within OA EOC between logistics (General Services and EMS to ensure "real time" situation awareness. ALAMEDA COUNTY EOC MEDICAL /HEALTH BRANCH • The Alameda County EOC Medical/Health Branch may be activated with Alameda County EMS leadership in conjunction with the MHOAC facilitating coordination with the Alameda County Health Care System including hospitals and transpoR providers. Refer to Section 8.07 for disaster communications stems . 8•~~ Disaster 3 ~ PROGRESS TO GATE: A specific frequency (e. g., CALCORD) or frequencies shall be Communicatio COMMUNICATION SYSTEMS: identified for interagency communication and coordination rig, during a disaster. Alameda County EMS ensures redundant and interoperable communications: • Med1 — (Alameda County EMS disaster email) OBJECTIVES: • ReddiNet Provide a mechanism for better communication between law enforcement and EMS and to allow for better Page 115 N ~ y C >. R Q~ a~i '_ ~ R o q~ 'o R ~ L ~ oG m ~ ~ Progress — 2078 Ob'ective — 2018-19 ~ W = y 3 ~ a> pf ~ UPDATED 9/18/19 y ~ d ~ ~ y aTi O j ~' 0 ~ • CAHAN • Mass Notification (Everbridge System customized for Alameda County; hosted by Alameda County Officer of Homeland Security and Emergency Services) • WebEOC • DHV/MRC • HAM Radios • 700!800 Megahertz Radios — EBRCSA • Ceil Phones • Satellite Phones • Social Media REDDINET • ACCESS AND UTILIZATION -expanded "users" beyond existing partners including fire departments with hospitals, prehospital providers (911- and Non-911 Permitted response into a warm zone to attempt to salvage lives affected by active shooter. Enhance disaster communications and preparedness to respond to multiple casualty incidents given reality of Hybrid Targeted Violence, Active Shooters, terrorism, and multi-site coordinated attacks. SHORT-RANGE Enhance ReddiNet capabilities and facilitate training for all EMS system partners o Conduct ReddiNet training for patient tracking for System ReddiNet Users including FRALs transport. o Maximize utilization of 911 and Non-911 Permitted Ambulance aroviders in a medical surge event. Ambulance Providers, clinics and skilled nursing facilities. Ensure communications via ReddiNet and EBRICs. • Facilitated ReddiNet Upgrades with new modules and permissions for system Assess feasibility of shared information management for disaster response partners in 2017-18; ensuring training and exercises for all resource tracking at Operational Area EOC. Currently, Alameda County ReddiNet Users including FRALS transport, health care facilities, GSA has an effective resource platform. EMS is seeking Alameda County OES, and the City of Oakland OES. access to these system for greater situation awareness. • Alameda County EMS considering a resource module using ReddiNet. EMS is considering other ReddiNet resource tracking PORTABLE RADIOS — 700/800 MEGAHERTZ EBRICS options. • Specific Alameda County EMS communications frequencies were identified for the EBRICS — 700/800 megahertz radios. Radios distribution plan completed. • Mission — to own and operate a "state of the art" P25 compliant communications system for the public agencies within Alameda and Contra Costa Counties 100% complete with placing EBRICS radio system in dispatch centers of all ALCO Non-911 Permitted Ambulance providers; conduct a weekly EBRICS radio test with the Non-911 Permitted Ambulance providers. All Non-911 Permitted Ambulance providers equipped with EBRCSA radio at end of 2017. CALIFORNIA HEALTH ALERT NETWORK (CAHAN) • ALCO EMS staff -Adele Pagan, IT (Lead) and Cynthia Frankel, RN (Support), have completed the required CAHAN Administrator training. California quarterly exercises are conducted with the Operational Area EMS system providers. LOCAL ALAMEDA COUNTY MASS NOTIFICATION SYSTEM • Everbridge — ALCO Once of Homeland Security has acquired a new mass notification system. The ALCO EMS Staff -Adele Pagan, IT, (Lead) and Cynthia Frankel, RN (Support) are also the points of contact for the EMS notification components. EMS contact updates verified in CAHAN system. AC ALERT Cynthia Frankel has completed the AC Alert training. Alameda County Health Care Services Agency (HCSA) will be implementing AC Alert in August 2018. INFORMATION MANAGEMENT UPGRADES — WEBEOC • Alameda Operational Area has transitioned from RIMS to the new WEBEOC information management system. • Alameda County EMS collaborating with Alameda County Sheriff's Department OES, General Services Agency, and Public Health to explore a shared information platform for resource tracking. EMS RESOURCE CONTACT LIST -DIRECTORY /METRICS Page 116 C d 3 .N-'y d r/1 °' ~. ~1 N ~ d ~ E m e ~ _ >. d ~ ~ ~ Progress - 2018 Objective - 2018-19 ~p W 3 .a~i Y a~ p~ ~ UPDATED 9/18/19 N d m t~ 0 ~' pC g ~ N o J ~ • Redundant communications and information management systems have been updated in 2017-18 with Health Care System points of contact for disaster events (ie. ReddiNet; Email distribution lists; and Alameda County Emergency Manager Association lists). Facility Surge and Resource Capability information is also included in the contact list and directories. $•fig Inventory of 3 Refer to previous sections and plans• The local EMS agency, in cooperation with the local OES, Resources 4.12 (Disaster Response) Progress Update Form 2018-19 shall develop an inventory of appropriate disaster medical • 4.15 (MCI Plans) Progress Update Form 2018-19 resources to respond to multi-casualty incidents and disasters likely to occur in its service area. (No Change) —Refer to the 2017 Alameda County EMS System Plan PROGRESS TO DATE: OBJECTIVE: Alameda County EMS continues to update personnel 24/7 contacts, inventories and Update and maintain inventories of disaster medical status of disaster medical resources including: resources • Health Care Facilities, HCFs, (hospitals, skilled nursing facilities, clinics, and dialysis centers) Approved ambulance providers (911 and Non-911 Permitted Ambulance Providers) in the county • Approved contracts with medical supply/equipment vendors • Region II —EMS Directors, MHOACs, Health Officers, and RDMHS/C with alternates • Committees (includes Disaster Preparedness Health Coalition, DPHC, ED Receiving Hospital Committees, and EMS Section —Fire Chiefs) Alameda County EMS has an updated EMS Master Resource —contact list directory and distribution lists to include the above listed organizations and their disaster/ 24/7 contacts including: • EMS Duty Officers • ReddiNet Primary and Secondary Contacts • EBRCs 700/800 Megahertz Radio Distribution Contact List • MRC • HCSA Leadership Team Emergency Contacts • Alameda County Emergency Managers Association Master Contact List The RDMHS has updated the web-based Metrics Resource and Personnel Management S ystem Directory which includes operational assets and plans: contact information for HCFs/prehospital providers; ACS caches; Chempacks; Disaster Trailers (deployment modules) and vendors. EMERGENCY SUPPLIES MCI DEPLOYMENT MODULES FOR MASS CASUALTY EVENTS • Planned and procured six MCI Deployment Modules in June 2018. • Disaster Mass Casualty Modules will be distributed throughout Alameda County to replace existing disaster trailers. SWAT-T TOURNIQUETS Procured approximately 6000 SWAT-T tourniquets via a UASI grant for distribution to every law enforcement officer/deputy within Alameda County. • Allows for immediate and potentially life-saving hemorrhage control at the "point-of- wounding" • To include training by ALCO EMS personnel. • The Metrics and MHOAC Manual have point of contacts to deploy the caches. Page 117 ~ ~ a R d E ' c E m R °' ~ ~ C >. _ Q ~ L ~ d oC ~ p~ ~ Progress - 2018 Objective - 2018-79 R W 7 y ~ 'C' a> O1 ~ UPDATED 9!18/19 N ~ d ~ N uTi J ~' 0 g v E The Alameda County 2017 and 2018 EMS Policy and Procedure Manual includes information on the disaster supplies including Chempack deployment and hospital contacts Refer to the 2018 Field Manual on the Alameda Count EMS website 8.09 DMAT 3 (No Change) -Refer to 2017 EMS System Plan EMS agencysha// establish and maintain relationships with Teams Alameda County supports the Region II DMAT team wi7h other Bay Area Counties. Mutual Aid DMAT teams in its area Agreements 10 Mutual Aid 3 (No Change) -Refer to 2017 EMS System Plan OBJECTIVE: Agreements Alameda County EMS currently serves as the RDMHC/S for Region II. Encourage signing of mutual aid (mutual support) * In a disaster and/or mutual aid event, Alameda County EMS supports the Alameda agreement by those few OA's in Region II which have yet County Emergency Operations Plan and the California Medical/Health Emergency to do so Operations Manual consistent with SEMS. PROGRESS TO DATE: MUTUAL SUPPORT AGREEMENTS: • RDMHS facilitated signed agreements for the majority of Region II's operational areas. 8.11 CCP 3 ~ No Change - (Refer to 2017 EMS System Plan - 8.11) The local EMS agency, in coordination with the local OES and Designation' PROGRESS TO DATE: county health officer(s), and using state guidelines, shall • Alameda County has designated potential Field Treatment Sites, FTS (previously designate Field Treatment Sites (FTS). known as Casualty Collection Points) OBJECTIVES: EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Project FTS SHORT-RANGE • Submitted proposal for Co-Location Clinic Field Treatment Site Project funded by HPP 2017-18. Identify sites likely to be outside of a significant Planned and developed assessment and Co-Location matrix. earthquake shake zone with enough space to house and • Exercise Scoae: Two linked exercises (Tabletop and Full Scale) tested the models operate an FTS with freeway access and the ability to control tragic into and out of the site. for side-by-side coordinated in-the-field victim stabilization between Emergency Expand options to assist in facilitating hospital expansion Medical Services (EMS) units and Community Health Centers (CHC). Models were and decompression of Operational Area (OA) during a developed with coordinators from Alameda County EMS and Community Health MCl/medical surge event (ie. Co-Location Clinic Field Centers of the Alameda Health Consortium through an independent consultant Treatment Site Project) Barbara Morita. • Full-scale exercise conducted Mav 30 and 31, 2018 at three clinic locations. CO-LOCATION PROJECT Co-located EMS FTS with Community Health Center SHORT-RANGE • Conduct assessment, revise plan, and conduct exercise: o Assess Community Health Center disaster medical surge plans; Assess side by side medical operations for autonomous medical entities $•12 Establishme 3 Refer to previous sections and plans: EMS agency, in coordination with the local OES, shall develop nt of CCPs 4.12 (Disaster Response) Progress Update Form 2018-19 plans for establishing Casualty Collection Points (CCP) and a • 4.15 (MCI Plans) Progress Update Form 2018-19 means for communicating with them. No Change - (Refer to 2019 Alameda County EMS Field Manual -MCI Policy and Field Treatment Site Plans) EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Project • Exercise ScoAe: Two linked exercises (Tabletop and Fuli Scale) tested the models for side-by-side coordinated in-the-field victim stabilization between Emergency Medical Services (EMS) units and Community Health Centers (CHC). Models were Page 118 ~ Y N C1 N '~ OI a~ ~ a ~ ~ ~ ~ ~ c g ~ m f _ ~ ~a ~ R Progress - 2018 Objective - 2018-19 R W t' a~ p~ $ UPDATED 9/18119 N d d aai =~ p `~ ~ ~~ yp ~~ developed with coordinators from Alameda County EMS and Community Health Centers of the Alameda Health Consortium through an independent consultant Barbara Morita. • Full-scale exercise conducted Mav 30 and 31, 2018 at three clinic locations. $~~ 3 Disaster 3 Refer to previous sections and plans: The local EMS agency shall review the disaster medical Medical 4.12 (Disaster Response) Progress Update Form 2018-19 training of EMS responders in its service area, including the Training 4.15 (MCI Plans) Progress Update Form 2018-19 proper management of casualties exposed to and/or contaminated by toxic or radioactive substances. PROGRESS TO DATE: AMBULANCE STRIKE TEAM LEADER IASTL) OBJECTIVE: • Led 2 Ambulance Strike Team Leader (ASTL) training courses open to California Alameda County EMS reviews disaster training of EMS Mutual Aid Region II provider agencies credentialing approximately 50 leadership responders and conducts training for service providers in its service area. personnel. AMBULANCE STRIKE TEAM: • Trained several fire departments and EMS providers regionally in Ambulance Strike Team /Medical Task Force operations —approximately 50 field leadership personnel trained. o Started and maintained the quarterly Region 2 RDMHS Ambulance Strike team leader course TACTICAL MEDICINE TECHNICIAN EDUCATION —COURSES • Developed, received POST and EMSA approval and ran our first 40 hour Tactical Medical Technician (TMT) class in Dublin. • Completed and gained statewide approval and EMS Commission approval for the Tactical Medicine Guidelines working closely with EMSA and POST. TACTICAL EMERGENCY MEDICAL SERVICES ITEMS) TRAINING: Provided Tactical Emergency Medical Services ITEMS) training to Paramedics Plus and Union City Police Department. Conducted Tactical Emergency Medical Services ITEMS) Training with Paramedics Plus, San Leandro Police, Oakland Police, Alameda County Sheriffs Department ACTIVE SHOOTER AND MASS VIOLENT THREAT EXERCISES • ALCO EMS has been a leader in providing direction, planning, support and training supplies for active shooter and mass violent threat exercises throughout the county and region. In addition to several planning meeting for each jurisdiction, below are the actual dates of the all-day exercises: o Berkeley PD/ Berkeley FD, P+ exercises April 19 and May 17, 2018 o Newark PD, ACFD. P+ exercises May 21 and May 24, 2018 n Livermore PD. LPFD, Reach, Cal star , P+ exercises July 16 and Aug 2, 2018 o Kaiser Permanente- OPD, P+. July 19 and July 20, 2018 • EMS Disaster and preparedness staff assisted local fire departments and law enforcement in conducting an active shooter response exercise in Livermore • Conducted active shooter training for: Union city PD 08/2016 and Berkley City PD 04/2017. Trained several fire department, EMS and law enforcement groups in medical response to active shooter incidents. Conducted active shooter training for ALCO Fire, Union city PD, Berkley city PD URBAN SHIELD Page 119 ~ 3 r 4► N OI a~ N fu v d = ~ ~ z vai ~ g d ,a ~ ~ ~ Progress - 2018 Objective - 2018-19 R W = N •3 '~ d p~ Y UPDATED 9/18119 N ~ d ~ y a~ p ~' 0 ~ Q J ~ • Organizer for Urban Shield Mass Casualty Incident full scale exercise September 9- 11, 2016, September 9-11, 2017 Tactical EMS Event, and upcoming 2018 exercise. • Alameda County EMS leads the EMS Medical Operations for Urban Shield URBAN SHEILD 2018 • Planning for urban shield 2018 scheduled September 8-9, 2018. • Planning to participate in the Yellow Command (Earthquake Scenario 96 hours post event) scheduled for September 6, 2018. The Alameda County EOC will be fully activated with EMS staffing the EOC Med/Health Branch. The goal is to support the shelter medical needs. PORT OF OAKLAND EXERCISE 2018 • Participated in large (FBI, OPD. OFD, ACSO, EMS, Port of Oakland) exercise named "Operation Seasickness" simulating a terrorist attack on a vessel with many contaminated victims. • "Transported" several victims to Highland Hospital, who participated as well. EBOLA AND INFECTIOUS DISEASE TRAINING Protected Measures provided by Alameda County EMS Medical Director. • Guidance for suspect cases provided to system partners. Hospital Site visits conducted for Ebola in 2015 with EMS Medical Director RDMHS Region II coordinated and attended an EMS/Ebola unit training offered in conjunction with Kaiser Permanente Oakland. • Conducted Ebola/Infectious Disease training for Regional stakeholders July 14, 2016 and in 2017. Conducted an Ebola Exercise with Kaiser Permanente Oakland and a Regional EMS team from Solano County November 2, 2016. NON-911 PERMITTED AMBULANCE PROVIDER TRANSPORT SURGE TABLETOP 8 CST • Conducted first annual non-emergency permitted ambulance provider system surge table top exercise. • Continue developing robust plan to more smoothly integrate these providers into the emergency response network in disaster and surge situations. Participated in first Coalition Surge Test held June 27, 2018. OFFICE OF HOMELAND SECURITY AND EMERGENCY SERVICES AND UASI • Alameda County EMS participates in UASI and the Sheriffs Department of Homeland Security and Emergency Services Training (ie. Everbridge Mass Notification Training) EXERCISES: • All Hospitals and EMS responders in Alameda County participate in the annual statewide exercises. • Effective response capabilities are required and tested for all hospitals to include: Medical Surge; Hospital Command Center activations: redundant and interoperable communications systems; and information sharing and disseminations with Alameda County EMS (Duty Officer and/or EOC Medical/Health Branch if activated). • These required capabilities are discussed and tested in each statewide medical /health exercise: November 17, 2016; and planned for the upcoming November 16. 2017 exercise). EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Proiect Exercise Scooe: Two linked exercises (Tabletop and Full Scale) tested the models for side-by-side coordinated in-the-field victim stabilization between Emergency Medical Services EMS units and Communit Health Centers CHC . Models were Page 120 E y £~ d N R Q~ R p R T _ ~ ~ ~ d oe ~ ~ ~ Progress — 2018 Objective — 2018-19 A W = '~ a~ pf ~ UPDATED 9/18/19 N P a> ~ ~ ~ a~ p ~' ~ ~ H v J ~ developed with coordinators from Alameda County EMS and Community Health Centers of the Alameda Health Consortium through an independent consultant Barbara Morita. • Full-scale exercise conducted Mav 30 and 31, 2018 at three clinic locations. ALAMEDA COUNTY MUTUAL AID FOR NAPA/SOLANO OPERATIONAL AREA WILDFIRES AST TEAMS • PARAMEDICS PLUS: o Initial deployment on Monday 10/9/17 at 0330 o Multiple Ambulances Strike Teams (AST's) deployed throughout the incident. o Ongoing EOC support functions throughout the incident o Demobilized on Saturday, 10/14 at 1630hrs • COUNTY PERMITTED NON-EMERGENCY TRANSPORT PROVIDERS: The following providers that operate in our County provided personnel and resources throughout this incident: o AMR/Sutter o Westmed o Pro-Transport 1 o Royal Ambulance o Norcal Ambulance o Falck o Falcon Refer to 2016 Alameda Count EMS S stem Plan 8.13 for additional information 8.14 Hospital 3 (Refer to 2017 Alameda County EMS System Plan — 8.14) The local EMS agency shall encourage all hospitals to ensure Plans PROGRESS TO DATE: that their plans for internal and external disasters are fully integrated with the county's medical response plan(s). EXERCISES: • All Hospitals in Alameda County participate in the annual statewide medical/health OBJECTIVE: exercises. Effective response capabilities are required and tested for all hospitals to Alameda County EMS ensures that the hospital plans for include: Medical Surge (including MCI patient tracking, HavBed polling, and customized assessment polling); Hospital Command Center activations; redundant internal and external disasters are fully integrated and and interoperable communications systems; and information sharing and tested with the county's medical response plans. dissemination with Alameda County EMS (Duty Officer, MHOAC, and/or EOC Medical/Health Branch andlor EMS Branch DOC if activated). These required capabilities are discussed and tested in each statewide medical /health functional exercise: -November 2018 (Novel Virus); and November 21, 2019 (Flood Scenario) o The 2018 Alameda County table-top exercise was held October 2, 2018. o The 2019 Alameda County table-top exercise will be held October 1, 2019 REDDINET TRAINING AND PRACTICD • All hospital partners are expected to be proficient in ReddiNet and familiar with the messaging, assessment, MCI, and HAvBED modules. • The ReddiNet Coordinator provides customized ReddiNet training with practice on- site at each hospitals The EMS emergency plans and policies are reviewed at each training. COALITION SURGE TEST • Co-Location Limited No Notice Hospital Evacuation —Coalition Surge Test (CST) Exercise held June 27, 2018. The "Dry Run" was held June 14, 2018. The simulated evacuation of Children's Hospital CST was held May 30, 2019. PORT OF OAKLAND EXERCISE 2018 Page 121 y d y R E ~£ R ~ L a ~ ;! ~ o ~ m p~ ~ Progress - 2018 Objective - 2018-19 W P d 3a' a~ ~ p~ ~ UPDATED 9/18119 u! ~ ~ aTi N 0 m o ~ ~ a J ~ • Participated in large (FBI, OPD. OFD, ACSO, EMS, Port of Oakland) exercise named "Operation Seasickness" simulating a terrorist attack on a vessel with many contaminated victims. • "Transported" several victims to Highland Hospital, who participated as well. DISASTER PREPAREDNESS HEALTHCARE COALITION (DPHC) • Alameda County Plans are reviewed and shared for consistency and alignment with the Alameda County EMS emergency plans and policies. • Alameda County EMS provides training for DPHC partners. The Medical Surge Week Skills training was held August 20, 2019. COLLABORATION PARTNERS AND COMMITTEES • Region II Disaster Medical/Health Coordinator/Specialist (RDMHC/S) • Region II Medical Health Operational Area Coordinator (MHOAC) Quarterly Meetings • Association of Bay Area Health Officers (ABAHO) • Alameda County local Jurisdiction Emergency Preparedness Committees and Hubs (including the City of Berkeley and Oakland) • Alameda County Hospital Emergency Preparedness Committee Meetings (including UCSF Benioff Children's Hospital and Alameda Health System) • EMSC, Pediatric Readiness, and Surge Planning Meetings • Western Regional Alliance Emergency Preparedness (WRAP-EM) Pediatric Surge Planning • California EMSA/CDPH Patient Movement Committee • Bay Area UASI Medical and Health Workgroup • Alta Bates Closure (Relocation/Reorganization) Task Force and Assessment (Impact Analysis) Subcommittee • California EMSA/CDPH Pediatric Surge Working Group Committee and the EMS Sub-Committee) • Alameda County Emergency Manager's Association (EMA) Committee • Alameda County Health Care Services Agency Leadership Emergency Operations Council and Workgroups • Co-Location Project Planning Group • NICU Surge Planning Workgroup Assigned by EMSA and CDPH leadership to participate in the Patient Movement Plan workgroup. • ABAHO Medical Shelter Workgroup Committee • ALCO EOP Children's Annex Workgroup Committee • UASI Yellow Command —Medical Shelter Planning Committee ALAMEDA COUNTY EOP. MHOAC MANUAL, MCI, AND MEDICAL SURGE PLANS Alameda County EMS has partnered with Alameda County Public Health on the Medical Surge projects. • The Mier Group contractor is conducting assessments from hospitals and other HCFs for the annual SWMHE for 2018 and 2019. • A medical surge framework has been developed with options for hospital expansion / decompression of critical care areas (including PICU and ICU). The pediatric Medical Surge Plan was revised. • The TRAIN Model is now recommended and tested in Alameda County with the Bay Area NICU Planning Surge Workgroup. • The pediatric surge projects will support the recommendations from the CDPH/EMSA Sur e Workin Grou and the EMS for Children Re ulations. Page 122 c y 3w m N ~~ d `m R Q~ ~~ R o R c ~ ~ ~ ~, ~ ~ ~ m Progress - 2018 Objective - 2018-19 ~p W ~ y ~ ~ a~ p~ ~ UPDATED 9/18/19 H ~ m ~ y a~ J ~`o g o ~ • A pediatric surge methodology and resources including a "how to" approach for planning and response will address pediatric patient movement coordinators and SMEs at the OA EOC Med/Health Branch when activated. • A pediatric surge coalition annex is being developed with the ALCO EMSC Coordinator and the Pediatric Surge Advisory Committee. Bed expansion, triage, and transportation will be integrated consistent with the CDPH/EMSA pediatric surge workgroup recommendations. Bi-Monthly DPHC Webinars and meetings provide a forum for pediatric surge education in 2018 and 2019. • The medical framework and pediatric surge coalition plan will be considered as attachments to the Alameda County MHOAC Manual which will be finalized in 2019- 20. PLAN/POLICY DISSEMINATION • HPP EMSA Coordinator —Provides educations and reviews hospital emergency and surge plans as needed to ensure alignment with Alameda County EMS plans. The Alameda County MCI Policy, ReddiNet Policy, EMSC Regulations, and medical surge expansion framework options were shared with the hospital partners at the Hospital Pediatric Readiness Site Visits; Disaster Preparedness Health Coalition (DPHC) meetings, ReddiNet on-site Trainings, and the Receiving Hospital Committee Meetings. The HPP EMSA Coordinator (also the EMS for Children Coordinator) has developed and shared the California Local Pediatric Surge CONOPs and the California Medical Children's Surge CON~Ps proposed draft framework with CDPH/EMSA. TRAINING • The RDMHS has provided EOM and Medical Health Operations Center Support Activities (MHOCSA) Training for DOC/EOC The RDMHS and MHOAC has provided a summary report and recommendations following the North Bay Fires 2018 with DPHC partners. 815 Interhospital 3 3 (Refer to 2018 EMS System Plan — 8.15) The local EMS agency shall ensure that there is an emergency Communicat PROGRESS TO GATE: system for inter-hospital communications, including operational procedures. ion COMMUNICATION SYSTEMS: Alameda County EMS ensures redundant and interoperable communications with system partners: OBJECTIVE: • Med1 — (Alameda County EMS disaster email) Alameda County EMS ensures there is a reliable • ReddiNet —Cynthia Frankel is the primary ReddiNet Coordinator emergency system for inter-hospital redundant and • CAHAN —Adele Pagan is the Primary CAAN Coordinator for EMS interoperable communications. • AC Aiert Mass Notification (Everbridge System customized for Alameda County; SHORT RANGE PLAN hosted by Alameda County Officer of Homeland Security and Emergency Services) Expand ReddiNet User group o Adele Pagan is the primary EMSC CAHAN & AC Aiert Coordinator Upgrade ReddiNet modules and permissions for current o Cynthia Frankel is the backup and exporting AC Alert contacts to ReddiNet &new users o The HCSA AC Alert System will be implemented in August 2018. • WebEOC — ALCO OES • HAM Radios • 700/800 Megahertz Radios • Cell Phones • Social Media PORTABLE RADIOS — 700/800 MEGAHERTZ • Specific Alameda County EMS communications frequencies were identified and received the EBRCSA — 700/800 megahertz radios including the 911 and non-911 Permitted Ambulance roviders Page 123 '~ ~ d N ~ N 01 N d t6 R Q~ E aY~i 'c E C R p = >, {0 ~ ~ i ~ d ~ m ~ ~ Progress - 2018 06jective - 2018-19 {a W ~ ~ a> p~ ~ UPDATED 9!18/19 H d d aai s~ O ~' d' ~ C' y p J ~ • Mission — to own and operate a "state of the art" P25 compliant communications system for the public agencies within Alameda and Contra Costa Counties • All Alameda County Receiving Hospitals received EBRCS 700/800 megahertz radios for their total 13 Hospital Command Centers • Monthly 700/800 megahertz radio checks conducted. REDDINET • The Alameda County EMS ReddiNet Coordinator —Cynthia Frankel has conducted ReddiNet training customized for FRALS ALS, LTC, ACRECC, and Hospitals. • An EMS System Notification Group was established on ReddiNet. • ReddiNet Assessment Module now includes the 5150 Receiving Facilities • Hospitals, Paramedics Plus. ACRECC, Hospitals, SNFs, and clinics received customized ReddiNet training scheduled in 2018 with focus on MCI patient tracking and customized poling. • REDDINET ACCESS AND UTILIZATION -expanding "users" beyond existing hospital partners including fire departments with hospitals and prehospital providers (Falck and non-Emergency Permitted Ambulance Providers, clinics and skilled nursing facilities). • Alameda County EMS recommended, planned, and implemented upgrades for ReddiNet modules and permissions for EMS partners including City of Oakland Dispatch, EOC, ACRECC, hospitals, SNFs, clinics, Falck, non-Emergency permitted providers. • Multiple clinics under the same organization now have access to ReddiNet (ie. West Oakland and East Oakland Health Centers) • ReddiNet utilization is continually monitored for all "real" events and exercises. ReddiNet reports are shared with hospitals at the Disaster Preparedness Health Coalition Meetings to evaluate consistent utilization and recommendations for im rovement. 8.16 Prehospital ,, ~ No Change - IRefer to 2017 EMS System Plan 8.161 The local EMS agency shall ensure that atl pre-hospital Agency Plans medical response agencies and acute-care hospitals in its ALAMEDA COUNTY MHOAC MANUAL service area, in cooperation with other local disaster medical Integrated Alameda County DMOP into Alameda County MHOAC Manual; -second response agencies, have developed guidelines for the draft completed management of significant medical incidents and have trained • The Incident Response Guides and select sections will be finalized in 2019-20. their staffs in their use. MCI POLICY SHORT RANGE PLAN Revision in 2019 and 2020 pending implementation. Finalize Alameda County MHOAC Manual Enhanced Level: Advanced Life Support: Page 124 c y ~ d H Ol N d c0 R Q ~ c ~ R `o ~ ~o c cn ~ ~ d~ _ ~ m ~ ~ ~ Progress - 2078 Objective - 2018-19 R w W 3 Y~ ~ m T p~ ~ L ~ UPDATED 9H 8/19 b! a ~ O y ~ p o ~ ~ a J E 8.17 ALS Policies ~ ~ Refer to 2017 EMS System Plan Update. The local EMS agency shall ensure that policies and PROGRESS TO DATE: procedures allow advanced life support personnel and mutual EMS FIELD MANUAL- aid responders from other EMS systems to respond and • 2019 Implemented; 2020 Implementation in progress function during significant medical incidents. • Refer to Alameda County EMS website. OBJECTIVES: o http://ems.acgov.orq/ClinicalProcedures/FieldTreatmtProtocols.page? Ensure EMS has policies and procedures to allow o http://ems.ac4ov.orq/ems-assets/docs/Documents- Forms/ALCO FM 2019%20FINAL.pdf advanced life support personnel and mutual aid EMERGENCY PLANS responders to be sent and received. The Alameda County emergency plans that address mutual aid for ALS providers include: Develop a Mass Gathering Event policy to provide better guidelines for medical personnel called to the scene of ALAMEDA COUNTY EMS SURGE PLAN JUNE 2019 8 JULY 2020 these events. o Refer to EMS Website Develop a Pediatric Response Coalition Plan with patient • ALAMEDA COUNTY EMERGENCY OPERATIONS PLAN movement plan and / or policy consistent with California o The ALCO EOP update is in final draft. The Children's Annex to the ALCO EOP Patient Movement Plan (including the pending Pediatric will be finalized with OES and GSA in 2019-20 Annex) • ALAMEDA COUNTY MHOAC MANUAL o Integrated Alameda County DMOP) second draft completed by Public Health LONG-RANGE PLAN) o Manual &Incident Response Guides to be finalized by EMS in 2019-20. Develop and finalize an Alameda County MHOAC Manual o Supports the Alameda County EMS Policies and Alameda County EOP Plan adapted from the California EMSA approved San consistent with the MHOAC program requirements Mateo MHOAC Guide Template in 2019-20 • EMS AND CLINIC FIELD TREATMENT SITE CO-LOCATION Proiect v Exercise Scope: Two linked exercises (Tabletop and Full Scale) tested the models for side-by-side coordinated in-the-field victim stabilization between Emergency Medical Services (EMS) units and Community Health Centers (CHC). Models were developed with coordinators from Alameda County EMS and Community Health Centers of the Alameda Health Consortium through an independent consultant Barbara Morita. o Full-scale exercise conducted Mav 30 and 31, 2018 at three clinic locations. • PEDIATRIC SURGE PLAN o In 2019-20, the Pediatric Surge Coalition Response Plan and pending MHOAC Manual will be revised consistent with the approved state Patient Movement Plan and CDPH/EMSA Pediatric Surge Workgroup recommendations. • CA MEDICAL HEALTH EOM AND PATIENT MOVEMENT PLAN o Alameda County EMS RDMHS and EMS for Children Coordinator is reviewing and developing plans consistent with the CA Patient Movement Plan -Pending Pediatric Annex. Enhanced Level: Specialty Care Systems: $•~ $ Specialty 3 Refer to 2017 EMS System Plan Update. Local EMS agencies developing trauma or other specialty care Center PROGRESS TO DATE: systems shall determine the role of identified specialty centers Roles DISASTER PLANNING AND RESPONSE -REQUIREMENTS: during a significant medical incidents and the impact of such Specialty Centers have plans and policies that identify their role in a disaster and/or incidents on day-to-day triage procedures. medical surge event. (Refer to information below). OBJECTIVE: • Specialty Centers participate in planning for major MCI, disaster, and surge events via the Disaster Preparedness Health Coalition (DPHC) and Receiving Hospital Alameda County EMS will ensure that policies and Committee procedures identify roles and responsibilities for • During a disaster or surge response, disaster communications, notifications, and significant MCIs, Surge, and disaster events for specialty instructions are provided to specialty centers via ReddiNet, Email, CAHAN, and centers including disaster communications. 7001800 Megahertz EBRCSA Radios as needed. • De endin on the size of a ma or disaster, s ecial centers includin Pediatric Page 125 ~ ~ ;~ E m ~~ c m~ c R 'a Q ~ ~ L ~ d R o` oC ~ t0 p~ ~ Progress — 2018 Objective — 2018-19 1~0 y W = y ~ ~ 1 ~ ~ p1 ~ v UPDATED 9/18/19 ~ ~ ~ N V J 0 E Receiving Centers (PedRCs) and trauma centers, may or may not function under the normal policies governing triage. The smaller the event, the greater the likelihood that the specialty centers will function as they normally do "day today." SIGNIFICANT MEDICAL INCIDENT REQUIREMENTS —Relevant Policies and Plans For specialty centers, relevant policies and plans that include disaster provisions are listed below: • EMS Surge Plan 2019 • EMS Field Manual — 2020 MCI Policy update in progress; CHEMPACK Deployment • EMS Administration Policies —Operations: Census Reporting; ReddiNet Utilization • EMS Administrative Policies -Programs • EMS Operations Policies • Alameda County Emergency Operations Plan 2019 (Final Draft) • Alameda County MHOAC Manual —second draft completed; final plan expected by January 2020 (Alameda County DMOP and Medical Surge Plan now integrated in MHOAC Manual and Disaster Preparedness Health Coalition Response Plan). • Alameda County Trauma Plan (revised 2019) • 700/800 Megahertz EBRCSA Radio Policy • California Medical/Health EOM —New Attachments (MHOAC Program) • California Patient Movement Plan SPECIALTY CENTERS — MOUs provide disaster provisions PEDIATRIC RECEIVING CENTERS (PedRCs) • —Pending Execution of MOUs CURRENT ALAMEDA COUNTY PRIMARY STROKE RECEIVING CENTERS • Alta Bates Summit Campus —Oakland • Alameda Health System —City of Alameda Hospital • Kaiser Permanente —Oakland • Kaiser Permanente —San Leandro • Kaiser Permanente Fremont • Washington Hospital —Fremont • Sutter Eden —Castro Valley • Stanford Va~leyCare as of September 4, 2019 Stanford ValleyCare-Pleasanton was scheduled for an initial JC site visit Q3 2019 for Primary Stroke Receiving Center Certification CURRENT ALAMEDA COUNTY STEMI /CARDIAC ARREST RECEIVING CENTERS • Alameda Health System —Highland • Alta Bates Summit Campus —Oakland Kaiser Permanente Fremont • Washington Hospital —Fremont • St. Rose • Stanford ValleyCare CURRENT TRAUMA CENTERS • UCSF Benioff Children's Hospitals, Oakland • Alameda Health System —Highland Hospital • Sutter —Eden Hospital UCSF BENIOFF CHILDREN'S HOSPITAL PEDIATRIC RELIEVING CENTER FOR PEDIATRIC TRAUMA Page 126 y ~ d N ~ ~ d fC R a~ ~ E R `o ~ T L ~ ;! ~ oC ~ ~ ~ Progress — 2078 Objective — 2018-19 R W 7 ~ ~ Of ~ UPDATED 9/18/19 N ~ ~ ~ g H ~ o 0 J ~ E • Coalition Surge Test —Considered role of specialty centers in evacuation. Tested evacuating of hospitals. Exercise held June 30, 2018 and May 30, 2019 Alameda County EMS has amulti-year contract with the pediatric trauma center UCSF Benioff Children's Hospital, Oakland (Level 1 Trauma Center) for collaboration to ensure hospital quality improvement for hospital pediatric "day the day' readiness, injury prevention, and disaster /surge capability. A new contract was implemented January 1, 2019. DISASTER SURGE ROLES FOR SPECIALTY CENTERS • All specialty hospitals participate in the Alameda County Disaster Preparedness Health Coalition (DPHC) to facilitate their understanding of their disaster response roles with focus on the EOM and MHOAC program. All specialty hospitals participate in annual SWMHE to discuss and test their disaster response roles. The functional "Novel Virus" exercised occurred November 15, 2018. All specialty centers will participate in the "Flood Scenario" November 21, 2019 SWMHE. The goals include testing EOC coordination, medical surge, and communications with cross sector healthcare partners. Enhanced Level: Exclusive Operating Areas/Ambulance Regulations: 8.19 yya~~~~g 3 (No Change) Local EMS agencies which grant exclusive operating permits Exclusivity shall ensure that a process exists to waive the exclusivity in the event of a significant medical incident. Page 127 TABLE 2: SYSTEM ORGANIZATION AND MANAGEMENT Reporting Year: 2018 NOTE: Number (1) below is to be completed for each county. The balance of Table 2 refers to each agency. Percentage of population served by each level of care by county: (Identify for the maximum level of service offered; the total of a, b, and c should equal 100%.) County: Alameda 2 A. Basic Life Support (BLS) B. Limited Advanced Life Support (LALS) C. Advanced Life Support (ALS) Type of agency a) Public Health Department b) X County Health Services Agency c) Other (non-health) County Department d) Joint Powers Agency e) Private Non-Profit Entity fl Other: 3. The person responsible for day-to-day activities of the EMS agency reports to a) Public Health Officer b) X Health Services Agency Director/Administrator c) Board of Directors d) Other: 4 Indicate the non-required functions which are performed by the agency: ova 100 Implementation of exclusive operating areas (ambulance franchising) X Designation of trauma centers/trauma care system planning _ X Designation/approval of pediatric facilities X Designation of other critical care centers X Development of transfer agreements Enforcement of local ambulance ordinance X Enforcement of ambulance service contracts X Operation of ambulance service Continuing education X Personnel training Operation of oversight of EMS dispatch center X Non-medical disaster planning Administration of critical incident stress debriefing team (CISD) Page 137 TABLE 2: SYSTEM ORGANIZATION AND MANAGEMENT (cont.) Administration of disaster medical assistance team (DMAT) Administration of EMS Fund [Senate Bill (SB) 12/612] Other: Other: Other: 5. 6 EXPENSES Salaries and benefits (All but contract personnel) $ 4,338,281 Contract Services (e.g. medical director) Operations (e.g. copying, postage, facilities) 2,813,630 Travel 4,767 Fixed assets Indirect expenses (overhead) 1,018,657 Subsidies: Ambulance and Fire Department First Responder pass through 5,938,091 EMS Fund payments to physicians/hospital 13,551,717 Dispatch center operations (non-staff 3,407,916 Training program operations Other: Other: Other: TOTAL EXPENSES $ 31,073,059 SOURCES OF REVENUE Special project grants) [from EMSA] $ 10,000 Preventive Health and Health Services (PHHS) Block Grant Office of Traffic Safety (OTS) State general fund County general fund Other local tax funds (e.g., EMS district) 19,875,122 County contracts (e.g. multi-county agencies) Certification fees 105,902 Training program approval fees 42,969 Training program tuition/Average daily attendance funds (ADA) Job Training Partnership ACT (JTPA) funds/other payments Base hospital application fees Page 138 TABLE 2: SYSTEM ORGANIZATION AND MANAGEMENT (cont.) Trauma center application fees Trauma center designation fees Pediatric facility approval fees Pediatric facility designation fees Other critical care center application fees Type: Other critical care center designation fees Type: Ambulance service/vehicle fees Contributions Other (Specify): Ambulance response time penalties 1,129,600 Other (Specify): County Health Tax Subsidy 435,514 Other (Specify): Refunds from prior overpayment 1,355,597 Other (Specify): Grants/Donations 268,716 Other (Specify): Unclaimed Money &Cash Overage 30 Other (Specify): Use of Available Fund Balance 7,743,991 Other grants: Other fees: Other (specify): Interest TOTAL REVENUE TOTAL REVENUE SHOULD EQUAL TOTAL EXPENSES. IF THEY DON'T, PLEASE EXPLAIN. TABLE 2: SYSTEM ORGANIZATION AND MANAGEMENT (cont.) 7. Fee structure We do not charge any fees X Our fee structure is: First responder certification EMS dispatcher certification EMT-I certification EMT-I recertification EMT-defibrillation certification EMT-defibrillation recertification 105,618 $ 31,073,059 $ N/A N/A 140 102 N/A N/A Page 139 AEMT certification AEMT recertification EMT-P accreditation Mobile Intensive Care Nurse/Authorized Registered Nurse certification MICN/ARN recertification EMT-I training program approval Agencies of Government, Hospitals, Colleges AEMT training program approval EMT-P training program approval Agencies of Government, Hospitals, Colleges MICN/ARN training program approval Base hospital application Base hospital designation Trauma center application Trauma center designation Pediatric facility approval Pediatric facility designation Other critical care center application Type: Other critical care center designation Type: Ambulance service license Ambulance vehicle permits Public Safety First Aid_ Agencies of Government_ Other: N/A N/A 100 N/A N/A 3000 1500 N/A 4500 2250 N/A 3000 (biennial) ~cn 3000 1500 Page 140 TABLE 2: SYSTEM ORGANIZATION AND MANAGEMENT (CONY.) FTE TOP SALARY BENEFITS CATEGORY ACTUAL TITLE POSITIONS BY HOURLY (%of Salary) COMMENTS (EMS ONLY) EQUIVALENT EMS Admin./ Coord./Director EMS Director 1 $77.21 N/A Asst. Admin./ Admin. Asst ./ Admin. Mgr. EMS Deputy Director 1 $66.18 ALS Coord./Field Coord./Trng Coordinator EMS Coordinator 1 $63.03 Program Coordinator/Field Liaison EMS Coordinator 1 $63.03 (Non-clinical) rauma Coordinator EMS Coordinator 1 $63.03 Medical Director Medical Director (Physician IV) 1 $125.25 Other MD/Medical ConsulUTraining Medical Director Deputy Medical Director (Physician IV) 1 $12525 Disaster Medical Planner Supervising EMS Coordinator 1 $66.79 Dispatch Supervisor EMS Coordinator 1 $63.03 Medical Planner EMS Coordinator 1 $63.03 Data Evaluator /Analyst Information Systems Specialist 1 $42.35 ~A / QI Coordinator EMS Coordinator 1 $63.03 Public Info. &Education Coordinator EMS Coordinator 1 $63.03 Executive Secretary Secretary II 1 $32.19 Other Clerical Specialist Clerk II 5 $27.59 Professional Standards EMS Coordinator 1 $63.03 Page 141 CATEGORY ACTUAL TITLE F7E POSITIONS (EMS ONLY) TOP SALARY BY HOURLY EQUIVALENT BENEFITS (%of Salary) COMMEfVTS Regional Disaster Medical Health Specialist (RDMHS) EMS Coordinator 1 $63.03 Information System Analyst Information Systems Manager Administration Specialist it 1 1 1 $56.88 $63.65 $41.02 Financial Services Specialist II Accounting Specialist I 1 1 $40.92 $29.16 Injury Prevention Manager Supervising Program Specialist 1 $51.47 Injury Prevention Specialist Program Specialist 1 $46.45 EMS Corps EMT Training Program Director Senior Program Specialist 1 $49.60 EMS Corps EMT Training Program Coordinator Program Specialist 1 $46.45 Page 142 v ~D' COG'L P i m U P C F ~ 'rCF 5 h El) 1GP~ Alameda County EMS July 2019 Emergency Preparedness & Response Supervising EMS Coordinator Jim Morrissey EMS Coordinator ,. Cynthia Frankel EMS Coordinator ~,rF ~~~It~,i ~J e.-~t1'15 Elsie Kuse'I~ EMS Coordinator Educational Kreig Harmon EMS Coordinator Aram Bronston~ ,, S. t Clerk TAP Elise Harris ,d. Clinical Systems of Care Physician IV ~~tedical birector Karl Sporer EMS Coordinator Sncrptan/ it Erica Campos' I EMS DiCecto~ Lauri McFadden Performance Finance & Analyst Administration ~~~ Information Systems Operations& Regulatory Compliance Information EMS Deputy `TMystems Mana~ Director Adele Pagan William McClurg i EMS Coordinator irrforrnation ~ System Lee Siegel Leo Derevin i EMS Coordinator ( Information . cnn-i h~~ ('ire ~YcXPmc Crecri~' Mike lacobs~ Wilman Woo ~ EMS UCSF Fellow (Contract? Lauren Hart EMS UCSF Fellow (Contract] 1ue ■I~w► Specialist Clerk ~. Sonya Lee Andrew Summa ~~ EMS Coordina#or Professional !~ Specialist Clerk 1 TAP Andrea Scruggs [Boxes with bolded borders, indicate managers/supervisors.] [Supervisor', Specialist Clerk positions.] Page 143 Scott Salter EMS Coordinator Community Trng & ~~ ,., Yolanda Takahash~' EMS Coordinator Contract Compliance ~~ Administrative Specialist I! William Tutol Injury Prevention ...:ng Q!'4?!'ll'Y1 .ripP~!~~fGt Kat Woolbright Program a list Carol Powers Program L Specialist Emma Olenberger Community Health Outreach Worker II w Program Specialist (OPEN) Spec c Clerk N L Specialist Clerk Michelle Barrientos Maria Ramos ~ Financial Services Specialist ~~ Accounting Specialist Career &Workforce Development Physician IV Program Dep Medical Dir Specialist Jocelyn Garrick Val re Senior Progr~ Program Services Coordinator Program Specialist ; Michael Gibson ! 1 Health Svcs Conslt I Health Services Community ~~~~ n , ;,;, ~n J Trainee - Health Outreach Michael Pham =~Q~~N~-- yLucretia Bo, b z Community Health Outreach Worker II -Case Deyantae Newsom EMS Corps Program Assistant ~~ EMT Instructor (Contract) .,Dave Licata. TABLE 3: STAFFING/TRAINING Reporting Year: 2018 NOTE: Table 3 is to be reported by agency. EMT - Is EMT -Its EMT - Ps MICN Total Certified 802 Number newly certified this year 388 Number recertified this year 414 Total number of accredited personnel on Jul 1 of the re ortin ear 118 Number of certification reviews resultin in: a) formal investigations 68 b) probation 4 c) suspensions 3 d) revocations 2 e) denials 4 fl denials of renewal 0 g) no action taken 37 Early defibrillation: a) Number of EMT-I (defib) authorized to use AEDs b) Number of public safety (defib) certified (non-EMT-I) 2. Do you have an EMR training program ,yes q no Los Positas Page 144 +TABLE 4: COMMUNICATIONS Note: Table 4 is to be answered for each county. County: Alameda Countv EMS Reporting Year: 2018 1. Number of primary Public Service Answering Points (PSAP) 14 2. Number of secondary PSAPs 2 3. Number of dispatch centers directly dispatching ambulances 4 4. Number of EMS dispatch agencies utilizing EMD guidelines 2 5. Number of designated dispatch centers for EMS Aircraft 1 6. Who is your primary dispatch agency for day-to-day emergencies? Alameda County Regional Emergency Communications Center 7. Who is your primary dispatch agency for a disaster? Alameda County Regional Emergency Communications Center 8. Do you have an operational area disaster communication system? Yes q No a. Radio primary frequency 700 MHz Trunked b. Other methods 800 MHz Trunked VHF c. Can all medical response units communicate on the same disaster X Yes No communications system? d. Do you participate in the Operational Area Satellite Information System ~ Yes q No e. Do you have a plan to utilize the Radio Amateur Civil Emergency Services 0 Yes q No 1) Within the operational area? 2) Between operation area and the region and/or state? ~ Yes q No Yes q No Page 145 Alameda County EMS Agency Agency Contact: Lauri McFadden, EMS Director 1000 San Leandro Blvd., Ste. 200 San Leandro, CA 94577 VOICE: (510) 618-2055 FAX: (510) 618-2099 E-MAIL: lauri.mcfadden@acgov.org Channel Use TX-Freq RX-Freq CTCSS Prim/Alt Local Medical Coordination (real time) 700/800 ~vlf-Iz N/A N/A N/A Trunked system Statewide Medical Coordination VMED 28 155.340 155.340 N/A N/A CALCORD 156.075 156.075 156.7 156.7 Calling Channel 700/800 MNz N/A N/A N/A Dispatch (for each EMS Agency) Trunked s stem 700/800 NtHz N/A N/A N/A Direct. to hospitals Trunked system, telephone 700/800 M~Iz N/A N/A N/A Other (e.g. tactical, etc.) For disasters 700/800 MHz N/A N/A N/A VMED 28 155.340 155.340 N/A N/A CALCORD 156.075 156.075 156.7 156.7 Emergency Department Facilities Alameda Hospital Alameda Health System 2070 Clinton Avenue Alameda, California 94501 Alta Bates Summit Medical Center Alta Bates Campus 2450 Ashby Avenue Berkeley, California 94705 Telephone (510) 522-3700 (510) 204-4444 Helipad Latitude/Lon~itude None None Alta Bates Summit Medical Center (510) 655-4000 None Summit Campus 350 Hawthorne Street Oakland, California 94609 Helipad Emer~encv Department Facilities Telephone Latitude/Longitude Highland Hospital (510) 437-4800 None Alameda Health System 1411 E.31 st Street Oakland, California 94602 Kaiser Permanente Fremont (510) 248-3000 None Medical Center 39400 Paseo Padre Parkway Fremont, CA 94538 Kaiser Permanente Oakland (510) 752-1000 None Medical Center 280 West Mac Arthur Blvd. Oakland, California 94611 Kaiser Permanente San Leandro (510) 784-4000 None Medical Center 2500 Merced Street San Leandro, California 94577 San Leandro Hospital (510) 357-6500 None Alameda Health System 13855 East 14th Street San Leandro, California 94578 Stanford Valley Care Medical Center (925) 847-3000 37° 41.39' N 5555 W. Las Positas Blvd. 121 ° 52.46' W Pleasanton, California 94588 TLOF — 64' X 64' St. Rose Hospital (510) 264-4000 None 27200 Calaroga Avenue Hayward, California 94545 Sutter Eden Medical Center (510) 537-1234 37° 41,93' N 20103 Lake Chabot Road 122° 5.35' W Castro Valley, California 94546 TLOF - 55' Diameter UCSF Benioff Children's Hospital (510) 428-3273 37° 50.17' N 747 52nd Street 122° 16.00' W Oakland, California 94609 TLOF - 39' x 39' Washington Hospital (5 l0) 797-1 I I I 37° 33.49' N 2000 Mowry Avenue 121° 58.68' W Fremont, California 94538 TLOF - 50' x 50' ~\ VEHICLE CHARACTERISTICS Emergency Providers Telephone TYPE AMB's TRANS EMT Alameda County Fire Department (510) 632-3473 G 4 yes ALS Alameda City Fire Department (510) 337-2100 G 4 yes ALS Albany Fire Department (510) 528-5770 G 2 yes ALS Berkeley Fire~Department (510) 981-3473 G 7 yes ALS American Medical Response (800) 913-9112 G 65 yes BLS/CCT/CCTP Arcadia Ambulance (925) 997-8910 G 2 yes .BLS Bay Medic Ambulance (925) 383-0111 G 14 yes BLS CALSTAR (800) 252-5050 GA 2 yes ALS CALFIRE (925) 862-2197 G 0 no ALS CHP (707) 253-4906 A 1 yes ALS Eagle Ambulance ~ (707) 315-6669 G 3 yes BLS/CCT East Bay Regional Parks District (510) 690-6607 GA 2 Air Rescues yes ALS Falck Alameda County (510) 566-4432 G 77 yes ALS Falck Nor Cal (IFT Division) (800) 344-9955 G 36 yes BLS/CCT Falcon Ambulance (510) 223-1171 G 24 yes BLS/CCT Fremont Fire Department (510) 494-4200 G 0 no ALS Hayward Fire Department (510) 583-4900 G 0 no ALS Livermore Pleasanton Fire Department (925) 454-2361 G 0 no ALS Norcal Ambulance (925) 452-3400 G 38 yes BLS/CCT Oakland Fire Department (510) 238-3856 G 0 no ALS Piedmont Fire Department (510) 420-3030 G 2 yes ALS ProTransport-lAmbulance (800) 650-4003 G 32 yes BLS/CCT Reach Helicopter (707) 575-6886 GA 2 yes ALS Royal Ambulance (510). 568-6161 G 71 yes BLS/CCT Sacramento Valley Ambulance (916) 465-0657 G 2 yes BLS/CCT Stanford Life Flight (650)-723-5578 GA 1 yes ALS United Ambulance (510) 671-0031 G 9 yes BLS/CCT Westmed Ambulance (888) 331-1420 G 8 yes BLS/CCT TABLE 5: RESPONSE/TRANSPORTATION Reporting Year: 2018 Note: Table 5 is to be reported by agency. Early Defibrillation Providers Number of EMT-Defibrillation providers All Providers are required to have EMT-Is who have had an AHA (or equivalent) BCLS course that includes defibrillation with AED. SYSTEM STANDARD RESPONSE TIMES (90T" PERCENTILE) Enter the response times in the appropriate boxes: Paramedics Plus MPDS Category Metro/Urban Suburban/Rural Wilderness Echo 8:30 min. 14:00 min. 18:00 min. Delta 10:30 min. 16:00 min. 22:00 min. Charlie 15:00 min 25:00 min. 28:00 min. Bravo 15:00 min. 25:00 min. 28:00 min. Alpha 30:00 min. 40:00 min. 40:00 min. Fire De artment Advanced Life Su ort Metro/Urban Suburban/Rural Wilderness MPDS CATEGORY: First Res onders Transport First Res onders Transport First Res onders Transport ECHO 08:30 min. 10:00 min. 08:30 min. 10:00 min. 08:30 min. 10:00 min. DELTA 08:30 min. 10:00 min. 08:30 min. 10:00 min. 08:30 min. 10:00 min. CHARLIE 08:30 min. 10:00 min. 08:30 min. 10:00 min. 08:30 min. 10:00 min. BRAVO 12:45 min. 18:00 min. 12:45 min. 18:00 min. 12:45 min. 18:00 min. ALPHA 12:45 min. 18:00 min. 12:45 min. 18:00 min. 12:45 min. 18:00 min. Page 146 TABLE 6: FACILITIES/CRITICAL CARE NEW Reporting Year: 2018 NOTE: Table 6 is to be reported by agency. Trauma Trauma patients: 1. Number of patients meeting trauma triage criteria 6347 (2018) 2. Number of major trauma victims transported directly to a trauma 5087 (2018) center by ambulance. Total #Trauma Activations: - UCSF Benioff Children's Hospital — 799 -Sutter Eden Medical Center -2595 - Alameda Health System —Highland Hospital — 2953 Total Trauma Patients transported to Trauma Centers - 6347 3. Number of major trauma patients transferred to a trauma center 4. Number of patients meeting triage criteria who weren't treated at a trauma center Emergency Departments Total number of emergency departments 1. Number of referral emergency services 2. Number of standby emergency services 3. Number of basic emergency services 4. Number of comprehensive emergency services Receiving Hospitals 1. Number of receiving hospitals with written agreements 2. Number of base hospitals with written agreements 702 (2018) N/A 13 0 0 13 0 11 1 Page 147 Alameda County Trauma Centers 2018 Children's Hos ital Eden Hos ital Hi hland Hos ital Total TRA Patient Count 799 2,595 2,953 Trauma Activations 564 1,655 2,802 Full Activation - Level I 91 348 592 Partial Activation -Level II 338 1,307 2,210 Pri/Direct Admit 9 3 1 Trauma Consultations 179 104 144 Activations (other) 245 0 0 Admissions after TRA/ED 787 1,606 1,354 Outcome 0 0 ~ 0 Lived 790 2,532 2,862 Died 9 63 91 Blunt Rate 774 2,459 2,529 Penetratin Rate 23 148 424 Male 498 1,625 1,966 Female 301 921 987 Page 148 TABLE 7: DISASTER MEDICAL Reporting Year: 2018 County: Alameda Countv EMS NOTE: Table 7 is to be answered for each county. SYSTEM RESOURCES 1. Casualty Collections Points (CCP) a. Where are your CCPs located? b. How are they staffed? c. Do you have a supply system for supporting them for 72 hours? ~ Yes q No 2. CISD Do you have a CISD provider with 24 hour capability? ~ Yes q No 3. Medical Response Team a. Do you have any team medical response capability? Yes q No b. For each team, are they incorporated into your local response plan? Yes q No c. Are they available for statewide response? ~ Yes q No d. Are they part of a formal out-of-state response system? q Yes ~ No 4. Hazardous Materials a. Do you have any HazMat trained medical response teams? ~ Yes q No b. At what HazMat level are they trained? "Specialty Trained" 8~ "First Responder Awareness Level." c. Do you have the ability to do decontamination in an emergency room? ~ Yes q No d. Do you have the ability to do decontamination in the field? ~ Yes q No OPERATIONS 1. Are you using a Standardized Emergency Management System (BEMs) that incorporates a form of Incident Command System (ICS) structure? ~ Yes q No 2. What is the maximum number of local jurisdiction EOCs you will need to interact with in a disaster? 13 cities 3. Have you tested your MCI Plan this year in a: a. real event? ~ Yes q No b. exercise? ~ Yes q No "Individuals who respond to and function within the Exclusion Zone (Hot Zone) or Contamination Reduction Zone (Warm Zone) must be members of specialty trained HazMat teams, trained in the use of self- contained breathing apparatus, selection of appropriate chemical protective suits and how to function in them. Other rescuers should be trained in accordance with Federal OSHA standards in OSHA 29 CFR 190.120 and California OSHA as defined in the California Code of Regulations, Title 8, Section 5192. " (Refer to Alameda county EMS 2015 Field Manual). Nearly all public safety providers have received haz-mat training in at least the "First ResponderAwareness Level." Many firefighter personnel trained to the first responder level.. Page 149 TABLE 7: DISASTER MEDICAL (cont.) 4. List all counties with which you have a written medical mutual aid agreement: All counties within California Mutual Aid Compact Region 2 5. Do you have formal agreements with hospitals in your operational area to participate in disaster planning and response? ~ Yes q No 6. Do you have a formal agreements with community clinics in your operational areas to participate in disaster planning and response? ~ Yes q No 7. Are you part of amulti-county EMS system for disaster response? ~ Yes q No 8. Are you a separate department or agency? q Yes ~ No 9. If not, to whom do you report? Alameda County Health Care Services Agency 8. If your agency is not in the Health Department, do you have a plan to coordinate public health and environmental health issues with the Health Department? 0 Yes q No Page 150 TABLE 8: Response/Transportation/Providers 2018 Note: Table 8 is to be completed for each provider by county. Make copies as needed. County: Alameda Provider: Alameda County Fire Department Response Zone: Alameda County Address: 6363 Clark Ave Dublin, CA 94568 Number of Ambulance Vehicles in Fleet: 4 Phone Average Number of Ambulances on Duty Number: (510) 632-3473 At 12:00 p.m. (noon) on Any Given Day: 1 Written Contract: xO Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: x q Transport x❑ ALS x❑ 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport ❑BLS q 7-Digit ❑Air q CCT ❑x Water q I FT Ownership: If Public: If Public: If Air: Air Classification: xO Public x0 Fire O City xO County O Rotary O Auxiliary Rescue O Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue Transporting Agencies 33141 Total number of responses 64 Total number of transports 33071 Number of emergency responses 5 Number of emergency transports 70 Number of non-emergency responses 59 Number of non-emergency transports N/A Total number of responses Number of emergency responses Number of non-emergency responses Air Ambulance Services N/A Total number of transports Number of emergency transports Number of non-emergency transports Page 151 TABLE 8: ResponselTransportation/Providers 2018 County: Alameda Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Albany Fire Department Response Zone: Albany Address: 1000 San Pablo Avenue Number of Ambulance Vehicles in Fleet: 2 Albanv. CA 94706 Phone Number: (510)528-5770 Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: 1 Written Contract: x0 Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: x❑ Transport x❑ ALS x❑ 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport ❑BLS q 7-Digit ❑Air q CCT ❑Water q IFT Ownership: If Public: If Public: If Air: Air Classification: x0 Public x0 Fire xO City O County O Rotary O Auxiliary Rescue O Private D Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue 1145 Total number of responses 1045 Number of emergency responses 100 Number of non-emergency responses N/A Total number of responses Number of emergency responses Number of non-emergency responses Transaortina Aaencies 802 90 712 Air Ambulance Se N/A Total number of transports Number of emergency transports Number of non-emergency transports ~rvices Total number of transports Number of emergency transports Number of non-emergency transports Page 152 TABLE 8: Response/Transportation/Providers 2018 County: Alameda Address: 120 Vista Ave. Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Piedmont Fire Department Response Zone: _Piedmont Number of Ambulance Vehicles in Fleet: 2 Piedmont, CA 94611 Phone Average Number of Ambulances on Duty Number: (510) 420-3030 At 12:00 p.m. (noon) on Any Given Day: 1 Written Contract: x0 Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: x❑ Transport x❑ ALS x0 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport ❑BLS q 7-Digit ❑Air q CCT ❑Water q IFT Ownership: If Public: If Public: If Air: Air Classification: xO Public xO Fire x~ City O County O Rotary O Auxiliary Rescue O Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue Transporting Agencies 802 Total number of responses 485 Total number of transports 585 Number of emergency responses 23 Number of emergency transports 217 Number of non-emergency responses 462 Number of non-emergency transports N/A Total number of responses Number of emergency responses Number of non-emergency responses Air Ambulance Services N/A Total number of transports Number of emergency transports Number of non-emergency transports Page 153 TABLE 8: Response/Transportation/Providers 2018 County: Alameda Address: Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Fremont Fire Department Response Zone: Fremont Number of Ambulance Vehicles in Fleet: 0 3300 Capitol Ave. Fremont. CA 94538 Phone Number: (510) 494-4200 Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: 0 Written Contract: xO Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: ❑Transport x❑ ALS x❑ 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport ❑BLS q 7-Digit ❑Air • q CCT ❑Water q I FT Ownership: If Public: If Public: If Air: Air Classification: x0 Public x0 Fire xO City O County O Rotary O Auxiliary Rescue O Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue Transporting Agencies 12012 Total number of responses N/A Total number of transports 11993 Number of emergency responses Number of emergency transports 19 Number of non-emergency responses Number of non-emergency transports Air Ambulance Services N/A Total number of responses N/A Total number of transports Number of emergency responses Number of emergency transports Number of non-emergency responses Number of non-emergency transports Page 154 TABLE 8: Response/Transportation/Providers 2018 County: Alameda Address: Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Livermore Pleasanton Fire Department Response Zone: Livermore/Pleasanton 3560 Nevada St. Pleasanton, CA 94566 Phone Number: (925) 454-2361 Number of Ambulance Vehicles in Fleet: 0 Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: 0 Written Contract: xO Yes O No Medical Director: D Yes xO No Svstem Available 24 Hours: Level of Service: 0 Transport x❑ ALS x❑ 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport ❑BLS q 7-Digit ❑Air q CCT ❑Water q I FT Ownership: If Public: If Public: If Air: Air Classification: x~ Public xO Fire xO City O County O Rotary O Auxiliary Rescue O Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue Transporting Agencies 10230 Total number of responses N/A Total number of transports 10073 Number of emergency responses Number of emergency transports 157 Number of non-emergency responses Number of non-emergency transports Air Ambulance Services N/A Total number of responses N/A Total number of transports Number of emergency responses Number of emergency transports Number of non-emergency responses Number of non-emergency transports Page 155 TABLE 8: Response/Transportation/Providers 2018 Note: Table 8 is to be completed for each provider by county. Make copies as needed. County: Alameda Provider: Berkeley Fire Department Response Zone: Berkeley Address: 2100 Martin Luther King, Jr. Way, Berkeley, CA 94704 Phone Number: (5101981-3473 Number of Ambulance Vehicles in Fleet: 7 Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: 4 Written Contract: xO Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: x❑ Transport x❑ ALS x❑ 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport q BLS q 7-Digit ❑Air q CCT ❑Water q I FT Ownershiu: If Public: If Public: If Air: Air Classification: xO Public xO Fire xO City O County O Rotary O Auxiliary Rescue D Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue Transporting Agencies 10973 Total number of responses 6770 Total number of transports 10749 Number of emergency responses 556 Number of emergency transports 224 Number of non-emergency responses 6214 Number of non-emergency transports Air Ambulance Services N1A Total number of responses N/A Total number of transports Number of emergency responses Number of emergency transports Number of non-emergency responses Number of non-emergency transports Page 156 TABLE 8: Response/Transportation/Providers 2018 County: Alameda Address: Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Hayward Fire Department Response Zone: Hayward 777 B St. Hayward. CA 94541 Phone Number: (510) 583-4900 Number of Ambulance Vehicles in Fleet: 0 Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: 0 Written Contract: xO Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: ❑Transport x❑ ALS x❑ 9-1-1 ❑x Ground xO Yes O No x❑ Non-Transport ❑BLS q 7-Digit ❑Air q CCT ❑Water 0 I FT Ownership: If Public: If Public: If Air: Air Classification: x~ Public xO Fire xO City O County O Rotary O Auxiliary Rescue O Private O Law D State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue 14086 Total number of responses 14075 Number of emergency responses 11 Number of non-emergency responses N/A Total number of responses Number of emergency responses Number of non-emergency responses Transporting Agencies N/A Total number of transports Number of emergency transports Number of non-emergency transports Air Ambulance Services N/A Total number of transports Number of emergency transports Number of non-emergency transports Page 157 TABLE 8: Response/TransportationlProviders 2018 County: Alameda Address: Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Oakland Fire Department Response Zone: Oakland 150 Frank H Ogawa Plaza Oakland. CA 94612 Phone Number: (510) 238-3856 Number of Ambulance Vehicles in Fleet: 0 Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: 0 Written Contract: xO Yes O No Medical Director: O Yes xO No System Available 24 Hours: Level of Service: ❑Transport x❑ ALS x❑ 9-1-1 x❑ Ground xD Yes O No x❑ Non-Transport q BLS q 7-Digit ❑Air q CCT ❑Water q I FT Ownership: If Public: if Public: If Air: Air Classification: xO Public xO Fire xO City O County O Rotary O Auxiliary Rescue O Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue Transporting Agencies 42470 Total number of responses N/A Total number of transports 42465 Number of emergency responses Number of emergency transports 5 Number of non-emergency responses Number of non-emergency transports Air Ambulance Services N/A Total number of responses N/A Total number of transports Number of emergency responses Number of emergency transports Number of non-emergency responses Number of non-emergency transports TABLE 8: Response/Transportation/Providers 2018 Note: Table 8 is to be completed for each provider by county. Make copies as needed. County: Alameda Provider: Paramedics Plus Response Zone: Alameda Cou Address: 575 Marina Blvd San Leandro, CA 94577 Phone Number: 510-746-5700 Number of Ambulance Vehicles in Fleet: 64 Average Number of Ambulances on Duty 45 At 12:00 p.m. (noon) on Any Given Day: Written Contract: xO Yes O No Medical Director: x0 Yes O No System Available 24 Hours: Level of Service: x❑ Transport x❑ ALS x❑ 9-1-1 ❑x Ground x0 Yes O No q Non-Transport x q BLS q 7-Digit ❑Air q CCT ❑Water q IFT Ownership: If Public: If Public: If Air: Air Classification: O Public O Fire O City O County O Rotary O Auxiliary Rescue xO Private O Law O State O Fire District O Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue 141808 Total number of responses (Cad EID Count) 108359 Number of emergency responses 33449 Number of non-emergency responses Transporting Agencies 101416 Total number of transports (Arrival Count) 7110 Number of emergency transports 94306 Number of non-emergency transports Air Ambulance Services N/A Total number of responses N/A Total number of transports Number of emergency responses Number of emergency transports Number of non-emergency responses Number of non-emergency transports Page 159 TABLE 8: ResponselTransportation/Providers 2018 County: Alameda Address: 1300 Park St. Note: Table 8 is to be completed for each provider by county. Make copies as needed. Provider: Alameda City Fire Department Response Zone: Alameda Number of Ambulance Vehicles in Fleet: 4 Alameda. CA 94501 Phone Number: 510-337-2100 Average Number of Ambulances on Duty 3 At 12:00 p.m. (noon) on Any Given Day: Written Contract: xO Yes O No Medical Director: O Yes xO No System A~~ailable 24 Hours: Level of Service: x❑ Transport x❑ ALS x❑ 9-1-1 ❑x Ground ~O Yes O No x❑ Non-Transport q BLS q 7-Digit ❑Air q CCT ❑Water q IFT Ownership: if Public: If Public: if Air: Air Classification: xO Public xO Fire xO City O County O Rotary O Auxiliary Rescue O Private O Law O State zO Fire District D Fixed Wing O Air Ambulance O Other O Federal O ALS Rescue Explain: O BLS Rescue 4551 Total number of responses 4547 Number of emergency responses 4 Number of non-emergency responses N/A Total number of responses Number of emergency responses Number of non-emergency responses Transporting Agencies 3896 Total number of transports 388 Number of emergency transports 3508 Number of non-emergency transports Air Ambulance Services N/A Total number of transports Number of emergency transports Number of non-emergency transports TABLE 8: ResponselTransportation/Providers 2018 Note: Table 8 is to be completed for each provider by county. Make copies as needed. County: Alameda County Provider: East Bay Regional Park District Response Zone Address: 17930 Lake Chabot Road Castro Valley, CA 94546 Phone Mobile:510-708-7181 Number: Office: 510-690-6607 N/A Number of Ambulance Vehicles in Fleet: 2 Air Rescue Units Average Number of Ambulances on Duty At 12:00 p.m. (noon) on Any Given Day: N/A Written Contract: xO Yes O No Medical Director. O Yes xO No System Available 24 Hours: x❑ Transport Level of Service: x❑ ALS x❑ 9-1-1 x❑ Ground xO Yes O No x❑ Non-Transport x❑ BLS q 7-Digit x❑ Air q CCT x❑ Water q I FT Air Trans ort Onl Ownership: if Public: ]f Public. if Air: Air ClassiCcation: x0 Public xO Fire O Citv O Count~~ xO Rotary O Auxiliary Rescue O Private x0 L~i~v O State xO District O Fixed Wing O Air Amb~ilance O Other O Federal xO ALS Rescue Explain: xO BLS Rescue Transporting Agencies 292 Total number of responses N/A Total number of transports 73 Number of emergency responses N/A Number of emergency transports 219 Number of non-emergency responses N/A Number of non-emergency transports Air Ambulance Services 175 Total number of responses 5 Total number of transports 24 Number of emergency responses 1 Number of emergency transports 151 Number of non-emergency responses 4 Number of non-emergency transports EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County EMS Agency Area or subarea (Zone) Name or Title: Alameda County EOA Name of Current Provider(s): Include company names) and length of operation (uninterrupted) in specified area or subarea. Paramedics Plus (November 1, 2011 to June 30, 2019) Area or subarea. (Zone) Geographic Description: The EOA includes all geographic areas of Alameda County, except for the incorporated cities of Alameda, Albany, Berkeley, and Piedmont, for which 911 ambulance services are provided through those cities' fire departments, and Lawrence Livermore National Laboratory, which contracts with the Alameda County Fire De artment for ambulance services. Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Exclusive See attached ambulance provider agreement'RECITALS OF AUTHORITY' Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): Include type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Emergency Ambulance, 9-1-1 Emergency Response Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifcations, or other changes to arrangements for service. If competitively-determined, method of competition, intervals, and selection process. Attach copy/draft of last competitive process used to select provider or providers. Method of competition: Competitive bid Intervals: Five years, with extension to 6/30/2019 Selection process. Request for Proposal (RFP). EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County EMS Agency Area or subarea (Zone) Name or Title: Alameda County EOA Name of Current Provider(s): Include company names) and length of operation (uninterrupted) in specified area or subarea. Falck Northern California (effective July 1, 2019) Area or subarea (Zone) Geographic Description: The EOA includes all geographic areas of Alameda County, except for the incorporated cities of Alameda, Albany, Berkeley, and Piedmont, for which 911 ambulance services are provided through those cities' fire departments, and Lawrence Livermore National Laboratory, which contracts with the Alameda County Fire De artment for ambulance services. Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Exclusive See attached ambulance provider agreement'RECITALS OF AUTHORITY' Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): ~nc~ude type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Emergency Ambulance Service, 9-1-1 Emergency Response, ALS Ambulance, Standby Service with Transportation Authorization. Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. If competitively-determined, method of competition, intervals, and selection process. Attach copy/draft of last competitive process used to select provider or providers. Method of competition: Competitive bid Intervals: Five years, No extension Selection process. Request for Proposal (RFP). EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County Emergency Medical Services Area or subarea (Zone) Name or Title: Lawrence Livermore National Lab Name of Current Provider(s): Include company names) and length of operation (uninterrupted) in specified area or subarea. Alameda County Fire Department Area or subarea (Zone) Geographic Description: Federal property known as Lawrence Livermore National Lab located south/east of the city of Livermore. Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Not applicable, Federal property Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): Include type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Not applicable, Federal property Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. Not applicable, Federal property Ifcompetitively-determined, method of competition, intervals, and selection process. Attach copy/draft of last competitive process used to select provider or providers. Not applicable, Federal property Page 189 EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County Emergency Medical Services Area or subarea (Zone) Name or Title: City of Piedmont Name of Current Provider(s): Include company names) and length of operation (uninterrupted) in specified area or subarea. Piedmont Fire Department Area or subarea (Zone) Geographic Description: City of Piedmont Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Exclusive Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): ~nc~ude type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Emergency Ambulance, 9-1-1 Emergency Response Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. Uninterrupted service, in the same manner and scope, prior to 1/1/81 Ifcompetitively-determined, method of competition, intervals, and selection process. Attach copy/draft of last competitive process used to select provider or providers. Not applicable Page 190 EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County Emergency Medical Services Area or subarea (Zone) Name or Title: City of Alameda Name of Current Provider(s): Include company names) and length of operation (uninterrupted) in specified area or subarea. Alameda Fire Department Area or subarea (Zone) Geographic Description: City of Alameda including the property known as Coast Guard Island Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Exclusive Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): Include type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Emergency Ambulance, 9-1-1 Emergency Response Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. Uninterrupted service, in the same manner and scope, prior to 1/1/81 Ifcompetitively-determined, method of competition, intervals, and selection process. Attach copy/draft of last competitive process used to select provider or providers. Not applicable Page 191 EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea,~the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County Emergency Medical Services Area or subarea (Zone) Name or Title: City of Albany Name of Current Provider(s): City of Albany Include company names) and length of operation (uninterrupted) in specified area or subarea. Prior to 1/1/81 Area or subarea (Zone) Geographic Description: City of Albany Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Exclusive Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): Include type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Emergency Ambulance, 9-1-1 Emergency Response Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. Uninterrupted service, in the same manner and scope, prior to 1/1/81 Ifcompetitively-determined, method of competition, intervals, and selection process. Attach copyldraft of last competitive process used to select provider or providers. Not applicable Page 192 EMS PLAN AMBULANCE ZONE SUMMARY FORM In order to evaluate the nature of each area or subarea, the following information should be compiled for each zone individually. Please include a separate form for each exclusive and/or nonexclusive ambulance zone. Local EMS Agency or County Name: Alameda County Emergency Medical Services Area or subarea (Zone) Name or Title: City of Berkeley Name of Current Provider(s): Berkeley Fire Department Include company names) and length of operation (uninterrupted) in specified area or subarea. Prior to 1/1/81 Area or subarea (Zone) Geographic Description: City of Berkeley, including State properly at UC Berkeley and Federal property at Lawrence Berkeley Lab Statement of Exclusivity, Exclusive or non-Exclusive (HS 1797.6): Include intent of local EMS agency and Board action. Exclusive Type of Exclusivity, "Emergency Ambulance", "ALS", or "LALS" (HS 1797.85): Include type of exclusivity (Emergency Ambulance, ALS, LALS, or combination) and operational definition of exclusivity (i.e., 911 calls only, all emergencies, all calls requiring emergency ambulance service, etc.). Emergency Ambulance, 9-1-1 Emergency Response Method to achieve Exclusivity, if applicable (HS 1797.224): If grandfathered, pertinent facts concerning changes in scope and manner of service. Description of current provider including brief statement of uninterrupted service with no changes to scope and manner of service to zone. Include chronology of all services entering or leaving zone, name or ownership changes, service level changes, zone area modifications, or other changes to arrangements for service. Uninterrupted service, in the same manner and scope, prior to 1/1/81 If competitively-determined, method of competition, intervals, and selection process. Attach copy/draft of last competitive process used to select provider or providers. Not applicable Page 193 TABLE 9: FACILITIES County: Alameda Countv Note: Complete information for each facility by county. Make copies as needed. Facility: Alameda Hospital (Alameda Health System) Telephone Number: (510) 522-3700 Address: 2070 Clinton Ave Alameda, Ca 94501 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency D Comprehensive Emergency Pediatric Critical Care Centers O Yes No Trauma Center: If Trauma Center what level: EDAPz O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll O Level lll D LeveI IV STEMI Center: Stroke Center: O Yes ~ No ~ Yes D No 1 Meets EMSA Pediatric Critical Care Center (PCCCJ Standards z Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 162 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Alta Bates Summit Medical Center Alta Bates Campus Address: 2450 Ashby Ave Berkeley, Ca 94705 Telephone Number: (510) 204-4444 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAP2 O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll D Level lll O LeveI IV STEMI Center: O Yes ~ No Stroke Center: O Yes ~ No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 163 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Alta Bates Summit Medical Center- Summit Campus Address: 350 Hawthorne Oakland, Ca 94609 Telephone Number: (510) 655-4000 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No D Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAPz O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll O Level lll O LeveI IV STEMI Center: Yes O No Stroke Center: Yes O No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 164 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Highland Hospital (Alameda Health System) Telephone Number: Address: 1411 E31st St Oakland. Ca 94602 5101437-4800 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency ~ Yes O No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAPZ O Yes No PICU3 O Yes No ~ Yes O No ~ Level I D Level II O Level III O Level tV STEMI Center: e Yes O No Stroke Center: O Yes ~ No Meets EMSA Pediatric Critical Care Center (PCCC) Standards z Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 165 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Kaiser Permanente San Leandro Medical Center Address: 2500 Merced st San Leandro Ca. 94577 Telephone Number: (510) 784-4000 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAPZ O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll O Level lll O LeveI IV STEMI Center: O Yes ~ No Stroke Center: Yes O No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 166 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Kaiser Permanente Oakland Medical Center Address: 3801 Howe St. Oakland Ca, 94611 Telephone Number: (510) 752-1000 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency D Comprehensive Emergency Pediatric Critical Care Center' EDAP2 PICU3 STEMI Center: Yes O No O Yes ~ No O Yes No Yes O No Stroke Center: Yes O No Trauma Center: O Yes ~ No ~ Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards If Trauma Center what level: O Level l O Level ll O Level lll O LeveI IV Page 167 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Kaiser Permanente Fremont Medical Center Address: 39400 Paseo Padre Pkwy Fremont, Ca 94538 Telephone Number: (510) 248-3000 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes e No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAPZ O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll O Level lll O LeveI IV STEMI Center: Yes O No Stroke Center: Yes O No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 168 TABLE 9: FACILITIES County: Alameda Coun Note: Complete information for each facility by county. Make copies as needed. Facility: San Leandro Hospital (Alameda Health System) Telephone Number: (510) 357-6500 Address: 13855E 14 St. San Leandro Ca 94578 Written Contract: Service: Base Hospital: Burn Center: D Yes ~ No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAPZ O Yes No PICU3 O Yes No O Yes ~ No O Level l O Level ll O Level lll O LeveI IV STEMI Center: O Yes ~ No Stroke Center: O Yes ~ No ' Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 169 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: St. Rose Hospital Telephone Number: Address: 27200 Calaroga Ave Hayward, Ca 94545 510) 264-4000 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes e No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAP2 O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll D Level lll O LeveI IV STEMI Center: e Yes O No Stroke Center: O Yes ~ No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 170 TABLE 9: FACILITIES County: Alameda Coun Note: Complete information for each facility by county. Make copies as needed. Facility: Sutter Eden Medical Center Address: 20103 Lake Chabot Rd. Castro Valley, Ca 94546 Telephone Number: (510) 537-1234 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center O Yes No Trauma Center: If Trauma Center what level: EDAP2 O Yes No PICU3 O Yes No ~ Yes O No O Level l ~ Level ll O Level lll O LeveI IV STEMI Center: O Yes ~ No Stroke Center: Yes O No Meets EMSA Pediatric Critical Care Center (PCCC) Standards Z Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 171 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: UCSF Benioff Children's Hospital Telephone Number: (510) 428-3000 Address: 747 51S St Oakland, Ca 94609 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' Yes O No Trauma Center: If Trauma Center what level: EDAPZ Yes O No PICU3 Yes O No ~ Yes O No ~ Level l O Level ll O Level lll O LeveI IV STEMI Center: ~ Stroke Center: O Yes ~ No O Yes ~ No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 172 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Stanford Valley Care Medical Center Telephone Number: Address: 5555 West Las Positas Blvd Pleasanton, Ca 94588 925) 847-3000 Written Contract: Service: Base Hospital: Burn Center: Yes O No D Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAPZ O Yes No PICU3 O Yes No O Yes ~ No O Level l O Level ll O Level lll O LeveI IV STEMI Center: Yes O No Stroke Center: O Yes ~ No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 173 TABLE 9: FACILITIES County: Alameda County Note: Complete information for each facility by county. Make copies as needed. Facility: Washington Hospital Healthcare System Telephone Number: Address: 2000 Mowry Ave Fremont Ca. 94538 510) 797-1111 Written Contract: Service: Base Hospital: Burn Center: Yes O No O Referral Emergency O Standby Emergency O Yes ~ No O Yes ~ No Basic Emergency O Comprehensive Emergency Pediatric Critical Care Center' O Yes No Trauma Center: If Trauma Center what level: EDAP2 O Yes No PICU3 O Yes No D Yes ~ No O Level l O Level ll O Level lll O LeveI IV STEMI Center: Yes O No Stroke Center: Yes O No Meets EMSA Pediatric Critical Care Center (PCCC) Standards 2 Meets EMSA Emergency Departments Approved for Pediatrics (EDAP) Standards 3 Meets California Children Services (CCS) Pediatric Intensive Care Unit (PICU) Standards Page 174 Galindo, Lisa@EMSA From: Harmon, Kreig. EMS <Kreig.Harmon@acgov.org> Sent: Monday, December 16, 2019 1126 AM To: Galindo, Lisa@EMSA Cc: McFadden, Lauri, EMS; McClurg, William, EMS Subject: RE: Training Programs and CE Providers Good morning Lisa, Here is the list of current CE providers for Alameda County. If you need this info in a different format or if you need it put into an updated Table 10, please let me know and I'll get that done ASAP. Alameda County EMS 1000 San Leandro Blvd. Suite 200 San Leandro, CA 94577 510-618-2050 Open to the Public Expires: 03/31/2020 Alameda County Fire Department 1426 164th Ave San Leandro, CA 94578 925-833-3473 Employees only Expires: 06/30/2020 Alameda Fire Department 1300 Park Street Alameda, CA 94502 510-337-2100 Employees only Expires: 04/30/2022 Alameda Health System 1411 E.315t Street Oakland, CA 94602 510-437-4641 Open to the public Expires: 09/30/2021 Albany Fire Department 1000 San Pablo Ave. Albany, CA 94706 510-528-5770 Employees only Expires: 09/30/2023 American Health Education 6761 Sierra Ct. Ste. G Dublin, CA 94568 800-483-3615 Open to the public Expires: 10/31/2023 American Medical Response 13992 Catalina Street San Leandro, CA 94577 510-564-0408 Employees Only Expires: 03/31/2022 Bay Area Training Academy 14275 Wicks Blvd. San Leandro, CA 94577 510-614-1420 Open to the public Expires: 07/31/2023 Berkeley Fire Department 2100 Martin Luther King Jr. Way, 2~d Floor Berkeley, CA 94704 510-981-5502 Employees only Expires: 10/31/2020 Camp Parks Fire Department 520 Mitchell Dr. Dublin, CA 94568 925-875-4902 Employees only Expires: 10/31/2020 Chabot College 25555 Hesperian Blvd. Hayward, CA 94545 510-723-7090 Open to the public Expires: 04/30/2020 City of Fremont Fire Department 3300 Capitol Ave, Bldg. B Fremont, CA 94537 510-494-4200 Employees only Expires: 05/31/2023 EMS Corps EMT Training Program 1000 San Leandro Blvd. Suite 200 San Leandro, CA 94577 510-618-2050 Open to the Public z Expires: 03/31/2020 Falck Northern California 28333 Industrial Blvd. Hayward, CA 94545 707-766-2413 Open to the public Expires: 05/31/2023 Hayward Fire Department 777 B Street Hayward, CA 94541 510-293-5049 Employees only Expires: 12/31/2023 Las Positas College 3033 Collier Canyon Road Livermore, CA 94550 925-373-5800 Open to the public Expires: 05/31/2020 Livermore/Pleasanton Fire Department 3560 Nevada Street Pleasanton, CA 94566 925-998-1087 Expires: 12/31/2019 Merritt College 12500 Campus Drive Oakland, CA 94619 510-301-4233 Open to the public Expires: 06/30/2021 Norcal Ambulance Service 3025 Independence Drive, Suite H Livermore, CA 94551 925-557-9702 Employees only Expires: 09/30/2023 Oakland Fire Department 47 Clay Street, Oakland, CA 94607 510-238-6950 Employees only Expires: 03/31/2020 Piedmont Fire Department 120 Vista Ave 3 Piedmont, CA 94611 510-420-3030 Employees only Expires: 03/01/2020 Project Heartbeat 333 Hegenberger Road, Suite 855 Oakland, CA 94621 510-452-1100 Open to the public Expires: 09/30/2020 Quest Nursing Education Center 2135 Broadway Oakland, CA 94612 510-452-1444 Open to the public Expires: 04/30/2021 Royal Ambulance 14472 Wicks Blvd. San Leandro, CA 94577 877-995-6161 Employees only Expires: 10/31/2020 United Ambulance 3530 Breakwater Court Hayward, CA 94545 925-786-3426 Open to the public Expires: 09/30/2021 Please let me know if you need any additional information. Thank you! Regards, Kreig Harmon, Paramedic EMS Coordinator Educational Programs Alameda County Emergency Medical Services Agency 1000 San Leandro Blvd., Suite 200, San Leandro, CA 94577 Cell: 510-495-4679 Office: 510-667-7984 krei~.harmonC~aceov.ore ~~s 4 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda County EMS Reporting Year: 2018 rvv i t: i agie ~i u is to qe compietea qy county. nnaKe copies to aaa Training Institution: American Health Education Address: 6761 Sierra Ct. Ste G as neeaea. Telephone Number: 800-483-3615 Dublin, Ca 94568 Student Open to the '"`Program Level EMT Eligibility: Public Cost of Program: Basic: $1995- Number of students completing training per year: 2875 Refresher: $375 Initial training: 130 Refresher: 174 Continuing Education: 116 Expiration Date: ~0-3~-~9 Number of courses: Initial training: 9 Refresher: 12 Continuing Education: 217 Training Institution: Chabot College Address: 25555 Hesperian Blvd Hayward, CA 94545 Student Open to the Eligibility: Public Cost of Program: Basic: 7.5 units x $46/ unit = **Program Level EMT-B Number of students completing training per year: Telephone Number: 510-723-7090 Refresher: 2 units Initial training: 46 x $46/ unit = $92 37 Refresher: N/A Continuing Education: N/A Expiration Date: 4/30/20 Number of courses Initial training: 2 Refresher: 2 Continuing Education: N/A * Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 175 Training Institution: Las Positas College Address: 3000 Campus Hill Dr. Livermore, CA 94551 Student Open to the **Program Level EMT Eligibility": Public Cost of Program: Basic: $600 Number of students completing training per year: Refresher: $68 Initial training: Refresher: Continuing Education: Expiration Date: Number of courses: Initial training: Refresher: Continuing Education: open to general public or restricted to certain personnel only. Telephone Number: 925-424-1000 x2046 3-31-20 1 N/A -- inaicace wnetner tnn i -i, HtM I , tm i -r, MIC:N, Of tMK; it tnere is a training program tnat otters more tnan one level complete an inrormation rot eacn level. Training Institution: Telephone Number: Las Positas College 925-424-1000 x2046 Address: 3000 Campus Hill Dr. Livermore, CA 94551 Student Open to the **Program Level Paramedic Eligibility*: Public Cost of Program: Basic: $3000 Number of students completing training per year: Refresher: N/A Initial training: 24 Refresher: 0 Continuing Education: N/A Expiration Date: 5-31-20 Number of courses: Initial training: 1 Refresher: 0 Continuing Education: Page 176 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda County Reporting Year: 2018 NOTE: Table 10 is to be completed by county. Make copies to add pages as needed. Training Institution: Unitek Education (FYI, Program ended service in 05/2019) Telephone Number: 510-743-2710 Address: 4670 Auto Mall Parkway Fremont, CA 94538 Student Open to the **Program Level EMT-B Eligibility*: Public Cost of Program: Basic: $4305 Number of students completing training per year: Refresher: $350 Initial training: 280 Refresher: 158 Continuing Education: 1336 Expiration Date: 8-31-20 Number of courses: Initial training: 14 Refresher: 9 Continuing Education: 109 'Open to general public or restricted to certain personnel only. *" Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Training Institution: Alameda County Fire De Address: 1426 164th Avenue San Leandro. CA 94578 Student Eligibility*: Employees only Cost of Program: Basic: N/A Refresher: N/A **Program Level EMT Number of students completing training per year: Initial training: Refresher: Continuing Education: Expiration Date: Number of courses: Initial training: Refresher: Continuing Education: Telephone Number: N/A N/A 750+ 6-30-20 N/A N/A 60+ 510-618-3485 "Open to general public or restricted to certain personnel only. ** Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 177 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda County Reporting Year: 2018 NOTE: Table 10 is to be completed by county. Make copies to add pages as needed. Training Institution: Alameda Fire Department Address: 1300 Park Street Telephone Number: 510-755-4302 Alameda, CA 94501 Student **Program Level EMT Eligibility`: Employees only Cost of Program: Basic: N/A Number of students completing training per year: Refresher: N/A Initial training: N/A Refresher: 6 Continuing Education: 104 Expiration Date: 5/31/22 Number of courses: Initial training: N/A Refresher: 2 Continuing Education: 16 "Open to general public or restricted to certain personnel only. ** Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Training Institution: Berkeley Fire Department Telephone Number: Address: 2100 MLK Jr. Way, 2"d floor Berkeley, Ca 94704 Student "*Program Level EMT ligibility'`: Employee only Cost of Program: Basic: N/A Number of students completing training per year: Refresher: N/A Initial training: N/A Refresher: N/A Continuing Education: 117 Expiration Date: ~o-s,-2o Number of courses: Initial training: N/A Refresher: 0 Continuing Education: 32 TABLE 10: APPROVED TRAINING PROGRAMS 925-875-4902 Page 178 County: Alameda Countv Reporting Year: 2018 NOTE: Table 10 is to be completed by county. Make copies to add pages as needed. Training Institution: Alameda County EMT Training Program Telephone Number: 510-708-9707 Address: 1000 San Leandro Blvd San Leandro. CA 94577 Student Restricted Eligibility*: *Oven to general public or **Program Level EMT Cost of Program: Basic: N/A Number of students completing training per year: Refresher: N/A Initial training: 36 Refresher: N/A Continuing Education: N/A Expiration Date: 3-31-20 Number of courses: Initial training: 2 Refresher: N/A Continuing Education: N/A to certain personnel only *" Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Training Institution: Fremont Fire Department Telephone Number: 510-494-4233 Address: 3300 Capital AVE, Building B Fremont, CA 94537 Student **Program Level EMT-1 Eligibility*: Employees only Cost of Program: Basic: N/A Number of students completing training per year: Refresher: N/A Initial training: N/A Refresher: N/A Continuing Education: 130 Expiration Date: 5-31-19 Number of courses: Initial training: N/A Refresher: N/A Continuing Education: 12 'Open to general public or restricted to certain personnel only. ** Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 179 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda Countv Reporting Year: 2018 Nu i t: i aaie ~ u is to ae comaietea av county. nnaKe copies to aaa paces as neeaea. Training Institution: Albany Fire Department Telephone Number: 510- 528-5770 Address: 1000 San Pablo Ave Albany, CA 94706 Student **Program Level EMT Eligibility": Employees only Cost of Program: Basic: N/A Number of students completing training per year: Refresher: N/A Initial training: N/A Refresher: 1 Continuing Education: 90 Expiration Date: 9-30-19 Number of courses: Initial training: N/A Refresher: 1 Continuing Education: 6 Training Institution: Bear EMT Training Program Address: 2407 Telegraph Ave Berkeley, Ca 94720 Student **Program Level EMT Eligibility*: MRC Students Cost of Program: Basic: $2,250 Number of students completing training per year. Refresher: $50 Initial training: Refresher: Continuing Education: Expiration Date: Number of courses: Initial training: Refresher: Continuing Education: Telephone Number: 831-426-9111 148 N/A `* Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 180 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda Countv Reporting Year: 2018 nu i t: i aaie ~ u is to ae compietea ay county. nnaKe copies to aaa pages as neeaea. Training Institution: NCTI- Livermore Address: 7575 Southfront Rd. Livermore, CA 94551 Student **Program Level EMT Eligibility*: General Public Cost of Program: Basic: $1875 Number of students completing training per year: Refresher: $325 Initial training: Refresher: Continuing Education: Expiration Date: Number of courses: Initial training: Refresher: Continuing Education: Training Institution Address: NCTI- Livermore 7575 Southfront Rd. Telephone Number: 925-454-6184 05/31 /23 0 .. Telephone Number: 925-454-6184 Livermore, CA 94551 Student "*Program Level EMT-P Eligibility": General Public Cost of Program: Basic: $9,750 Number of students completing training per year: Refresher: N/A Initial training: 74 Refresher: 0 Continuing Education: N/A Expiration Date: 12-3~-2~ Number of courses: Initial training: 3 Refresher: 0 Continuing Education: Multiple Open to general public or restricted to certain personnel only. "" Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 181 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda Countv Reporting Year: 2018 NOTE: Table 10 is to be completed by county. Make copies to add pages as needed. Training Institution: Bay Area Training Academy Telephone Number: Address: 14275 Wicks Blvd Student Eligibility*: San Leandro, CA 94577 Open to Public **Program Level EMT Cost of Program Basic: X2285 Number of students completing training per year: Refresher: X334 Initial training: 220 Refresher: 10 Continuing Education: N/A Expiration Date: 7-31-19 Number of courses: Initial training: 11 Refresher: 2 Continuing Education: N/A 915-528-9180 "open to general public or restricted to certain personnel only. *'` Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Training Institution: Merritt College Telephone Number: Address: 12500 Campus Drive Oakland, Ca 94619 Student Open to Public "*Program Level EMT ligibility*: Cost of Program: Basic: $26 Number of students completing training per year: p/unit Refresher: $26 Initial training: 75 p/unit Refresher: 0 Continuing Education: N/A Expiration Date: 6-30-21 Number of courses: Initial training: 3 Refresher: 0 Continuing Education: N/A nPn to aanPral nuhlir. nr rPsfirirtarl to r.Prtain nersnnnal nnly 510-436-2409 ** Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 182 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda County Reporting Year: 2018 NOTE: Table 10 is to be completed by county. Make copies to add pages as needed. Training Institution: Oakland Fire Department Address: 47 Clay Street Oakland, Ca 94607 Student Employees only Eligibility'`: Cost of Program: Basic: N/A Refresher: N/A Telephone Number: 510-238-6957 **Program Level EMT Number of students completing training per year: Initial training: 0 Refresher: 0 Continuing Education: 2,226 Expiration Date: 3-31-20 Number of courses: Initial training: 0 Refresher: 0 Continuing Education: 348 Training Institution: Livermore Pleasanton Fire Department Telephone Number: 925-998-1087 Address: 3560 Nevada St Pleasanton, CA 94566 Student ""Program Level EMT Eligibility`: Employees only Cost of Program: I Basic: N/A Number of students completing training per year: Refresher: N/A Initial training: N/A Refresher: N/A Continuing Education: 112 Expiration Date: 12-31-19 Number of courses: Initial training: N/A Refresher: 6 Continuing Education: N/A "Open to general public or restricted to certain personnel only. ** Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 183 TABLE 10: APPROVED TRAINING PROGRAMS County: Alameda County Reporting Year: 2018 NOTE: Table 10 is to be completed by county. Make copies to add pages as needed. Training Institution: Address: Student Eligibility'' Restricted Training Institution: Address: Student Eligibility': Public Berkeley STEP 1701 San Pablo Ave Berkeley, CA 94702 'Program Level EMT Cost of Program: Basic: $1,250 Number of students completing training per year: Refresher: Initial training: Refresher: Continuing Education: Expiration Date: Number of courses: Initial training: Refresher: Continuing Education: Quest Nursing 917 Harrison Street Oakland, CA 94612 `Program Level EMT Cost of Program: Basic: 1,250 Number of students completing training per year: Refresher: Initial training: Refresher: Continuing Education: Expiration Date: Number of courses: Initial training: Refresher: Continuing Education: Telephone Number: 510-644-6130 25 N/A N/A 9-30-22 1 N/A N/A Telephone Number: 510-452-1444 5 0 0 0 *Open to general public or restricted to certain personnel only. *'` Indicate whether EMT-I, AEMT, EMT-P, MICN, or EMR; if there is a training program that offers more than one level complete all information for each level. Page 184 TABLE 11: DISPATCH AGENCY County: Alameda County EMS Reporting Year: 2018 NOTE: Make copies to add pages as needed. Complete information for each provider by county. Name: Address: Telephone Number: Written Contract: Yes q No Ownership: Public q Private Alameda County Regional Emergency Communications Center 7000 East Ave., L-338 Livermore, CA 94551 (925) 423-1803 Medical Director: Day-to-Day 0 Yes q No Disaster NOTE -Current ACRECC staffing is: 36 EMD Positions 25 Filled 21 Dispatchers 11 Vacant Dispatcher position 4 Supervisors 1 EMDQ Manager 1 CAD System Administrator If Public: Fire q Law Other Explain: EOA Ambulance Contractor -Paramedics Plus Primary Contact: Rosa Ramos Phone: (925) 918-1803 Email: rosa.ramos@acgov.org Number of Personnel Providing Services: 36 EMD Training EMT-D ALS BLS LALS Other If Public: ❑City 0 County ❑State ❑Fire District ❑Federal Page 185 TABLE 11: DISPATCH AGENCY County: Alameda County EMS Reporting Year: 2018 NOTE: Make copies to add pages as needed. Complete information for each provider by county. Name: Address: Telephone Number: Jritten Contract: Yes q No Ownership: e Public q Private Oakland Fire Department 250 Fallon St Oakland, Ca 94607 (510) 238-6725 Medical Director: Day-to-Day Yes q No Disaster If Public: Fire q Law q Other Explain: _ Primary Contact: Stewart McGehee Phone: 510-238-3736 Email: smcgehee@oaklandnet.com Number of Personnel Providing Services: (23 positions) 24 EMD Training EMT-D ALS BLS LALS Other If Public: ~ City ❑County ❑State ❑Fire District ❑Federal NOTE -Current OFD Dispatch staffing is: 24 EMD Positions 24 Filled Of 24 EMD-trained Staff, 1 is a Fire Communications Manager, 5 are Supervisors, and 18 are Dispatchers Page 186