HomeMy WebLinkAboutbos-presentation-1-20-2022-finalAlameda County
EMS System Update
Lauri McFadden, EMS Director
Agenda EFFECTS OF COVID ON HEALTH CARE & THE EMS SYSTEM
FALCK COMPLIANCE
MITIGATION EFFORTS
EMS SYSTEM REDESIGN STATUS UPDATE
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Effects of
COVID on
Health Care
and the EMS
SystemHospital, LTCF, & SNF Staffing
Ambulance Patient Offload Times
Hospital Admissions 9-1-1 Call Volume
EMS System Provider Quarantine
ALL EXACERBATED WITH
OMICRON SURGE
Falck
Compliance
December Compliance
Falck remains non-compliant in 2 zones, North and East Metro Code 3.
South Metro Code 3 is compliant for 1st time since August.
Of the 27 zones monitored each month, in December 2021, Falck met or exceeded performance standards in 25, with more than 95% on-time compliance in 22 zones.Falck was also on-time for 100% of their calls in 9 zones.
Falck is still on a Corrective Action Plan (CAP), which was initiated after performance deficiencies in August and September.
Penalty Assessment for December: $135,000.00
($75,000 for December and $60,000 for continued Non-Compliance under the CAP)
Falck remains committed to serving Alameda County and is putting forth the effort to improve 9-1-1 ambulance responses in their EOA while continuing to be the safety net ambulance provider to the Fire transport cities within the County.
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Performance
Trend
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The 3 zones in which there has been performance deficiencies (<90%) since August have trended in the positive direction over the last 3 months, with the zone in the South becoming compliant in December.
In-County
9-1-1
Ambulance
Mutual Aid
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In-county 9-1-1 ambulance resources are shared through mutual aid as a safety-net between EOAs. Falck can provide support to the City of Alameda, Albany, Berkeley, and Piedmont when needed. In turn these cities, as well as Alameda County Fire Department who has ambulances at Lawrence Livermore Labs, can provide support to Falck.
Mitigation
Efforts
•Continued Staff Recruitment Efforts
•Hiring and Referral Bonuses
•Hired Local Recruiters and Leveraging Corporate Recruiter
•Continuous Re-evaluation of Posting Locations
•Revising Response Plans
•Ensuring quickest access to transport resources
•Engaging Hospitals to Address APOT Challenges
•Individual engagement and County Engagement with Hospital Leadership
•Engaging with other Ambulance Companies to evaluate partnership opportunities
•Engaging with Fire Departments to provide ambulances for them to staff within their jurisdictions
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Alameda County
EMS System Redesign
Community Education, Engagement, and Input
Redesign
Fundamentals
EMS System (9-1-1 Ambulance System) Redesign
•Equitable Access
•Fiscal Responsibility
•Appropriate Destination for All Patients
•Sustainability
Now is our chance to make our EMS system better!We are soliciting community feedback to accomplish that.
User experience, system partner feedback, and technical regulatory requirements inform the system redesign.
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EMS System
Financial Stability /
Service
Reimbursement
EMS Workforce Evolving Patient &
Community Needs
System Performance
Benchmarks Technology
•Leverage variety of
funding sources to
include IGT, ET3, and
potential fees or taxes
•Mechanism for
continual payer mix
and fiscal analysis
•Consider financial
impacts of different
model types
•Support for a public
model
•Focus on staff safety
and well-being
•Continue workforce
protections
•Greater workforce
input into equipment
and ambulances
•Increased legislative
engagement to
mitigate barriers and
create new paths to
serve community
•Provide better
integration of services
in a more accessible
way
•Provide focused
attention, education,
and training
pertaining to
populations requiring
specialty care
•Ability to evaluate
continuity of care
from phone call to
outcome
•Health Data Exchange
with Hospitals
•More fluid and
dynamic approach to
call prioritization
based on data
•Balance response
time vs. clinical need
vs. outcome
•↑ interoperability
•Operational
awareness of all
resources not just 911
•Telehealth
•Text to 911
•Dispatch Initiated
Triage and Navigation
by an imbedded
clinician
•Better communication
between field and
hospitals/alternative
destinations
System Partner Workgroup Recommendations & Priorities
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Community
Engagement
Forums to present the EMS Redesign in order to foster discussion and feedback have been held or are scheduled with the following community groups:
•Public Health Commission
•REACH
•Older Adult Service Providers
•Access and Functional Needs Community
•Community At Large
•COVID Advisory Group
•City Managers
•EMS System Partners & Stakeholders
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Biggest
Challenges
Facing
EMS SystemStaffing
System StructureAddressing Community Needs
Hospital Saturation
Financial Stability One Pathway Model
Current 9-1-1 ambulance response
9-1-1 Called by
Citizen
Call Answered
and Triaged by
Dispatch
Available
Ambulance Sent
to Call
Transport to
Hospital
Patient Care
Transferred at
Hospital
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Envisioned System
9-1-1 Called
by Citizen
Call
Answered
and Triaged
by Dispatch
Available
Resource
Sent
Dispatch
Center
Clinician
Telemedicine
Hospital Transport Alternative Destinations Referral
Guidance Referral Connection to Resources
Guidance Referral Connection to Resources
Call
Prevention
Through
Community
Education
Community
Paramedicine
Community
Paramedic
Follow Up
Reduce
Readmission
to Hospitals
Reduce
Repeated 911
Activations
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Community Experience-Scenario 1
Current System
•Ambulance and Fire Department dispatched.
•Patient transport to Hospital Emergency Room.
•Patient billed for transport and ER services.
Envisioned System
•Call triaged to telehealth or dispatch clinician.
•Symptoms assessed by RN or MD.
•Potential for prescription if needed.
•Referral for primary care services.
•Patient never leaves home.
•No transport, ER bill, or addition to hospital saturation.
Individual calls 9-1-1 due to ear pain. Feels like previous ear infection. No
primary care provider. No transportation to get to hospital to be seen.
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Community Experience-Scenario 2
Current System
•Law Enforcement, Ambulance and Possibly Fire Dept responds.
•Individual potentially placed on 72-hour hold.
•Individual transported to John George or Emergency Room.
•Billed for transport and services at destination facility.
Envisioned System
•Telehealth or alternative specialized behavioral health response without law enforcement.
•Behavioral Health Assessment and use
of Community Health Record to determine links to resources.
•Explore alternatives to 72-hour hold.
•Ability to refer for services or transport
to alternate destinations such as clinics, crisis facilities, or to private behavioral health provider.
9-1-1 called for an adult experiencing a behavioral health crisis. There is
no evidence of violent behavior, ingestion, or injury requiring medical
intervention.
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Redesign Timeline and Next Steps
MILESTONES TIMEFRAME
Continued Community Engagement/Education Through Mid-February 2022
Additional Input Accepted at: EMS.Redesign@acgov.org Through Mid-February 2022
Consultant Process Complete by Mid-February 2022
System Evaluation and Input Analysis February to April 2022*
RFP Development April to September 2022*
RFP Release October 2022*
Completion of RFP and Selection Process June 2023
New Ambulance Contract Starts July 2024
*Tentative Dates –Subject to Change as Needed 17
Summary
COVID has impacted all of Health Care to include
EMS and the Omicron variant has exacerbated those
impacts.
Falck performance is improving, and more mitigation
efforts are continually being implemented in order
to meet performance benchmarks.
Redesign is moving forward with community
meetings and progress will accelerate once
consultant is onboarded in following weeks pending
approval of procurement.
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