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Home My WebLink About2026-continuous-quality-improvement-plan ALAMEDA COUNTY EMERGENCY MEDICAL SERVICES (EMS) CONTINUOUS QUALITY IMPROVEMENT PLAN 2026 Plan Do Act Study What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Institute for Healthcare Improvement (IHI) Model for Improvement Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Table of Contents I. Introduction ................................................................................................................................................... 3 AUTHORITY .................................................................................................................................................. 3 ALAMEDA COUNTY EMERGENCY MEDICAL SERVICES AGENCY ....................................................................... 3 MISSION, VISION, AND VALUES ..................................................................................................................... 4 GOALS AND OBJECTIVES .............................................................................................................................. 5 CQI FRAMEWORK ........................................................................................................................................ 5 II. Structure, Organizational Description, Responsibilities ......................................................................... 6 ALAMEDA COUNTY DEMOGRAPHICS .............................................................................................................. 6 ALAMEDA COUNTY ORGANIZATIONAL CHART ................................................................................................. 7 EMS SYSTEM STAKEHOLDERS ..................................................................................................................... 8 SPECIALIZED PROGRAMS.............................................................................................................................. 9 QUALITY IMPROVEMENT RESPONSIBILITIES: GENERAL GUIDELINES .............................................................. 10 QUALITY IMPROVEMENT RESPONSIBILITIES: ALAMEDA COUNTY EMS AGENCY .............................................. 10 QUALITY IMPROVEMENT RESPONSIBILITIES: DISPATCH COMMUNICATION CENTERS ....................................... 11 QUALITY IMPROVEMENT RESPONSIBILITIES: EMS CLINICIAN AGENCIES ........................................................ 11 QUALITY IMPROVEMENT RESPONSIBILITIES: ALS BASE HOSPITAL ................................................................ 12 QUALITY IMPROVEMENT MEETINGS ............................................................................................................. 13 III. Data Collection and Reporting ................................................................................................................ 14 EMS DATABASES AND ANALYTIC PLATFORMS.............................................................................................. 14 EMS EVENT REPORTING ............................................................................................................................ 15 IV. Evaluation of Indicators........................................................................................................................... 16 SYSTEM EVALUATION PRINCIPLES .............................................................................................................. 16 CALIFORNIA EMS CORE QUALITY MEASURES ............................................................................................. 16 ALAMEDA COUNTY EMS AGENCY INDICATORS ............................................................................................ 17 EMS PROVIDER AGENCY, DISPATCH, AND BASE HOSPITAL INDICATORS ....................................................... 19 V. Action to Improve ...................................................................................................................................... 21 IMPROVEMENT METHODOLOGY ................................................................................................................... 21 IMPROVEMENT PITFALLS ............................................................................................................................. 22 PURSUING HEALTH EQUITY WITH IMPROVEMENT SCIENCE ........................................................................... 23 VI. Training and Education ........................................................................................................................... 24 EDUCATION PRINCIPLES ............................................................................................................................. 24 EMS PROTOCOL UPDATES, TRAININGS, AND EDUCATION ............................................................................ 24 COMMUNITY OUTREACH AND EDUCATION .................................................................................................... 25 VII. Annual Update ......................................................................................................................................... 27 2024 CQI UPDATES ................................................................................................................................... 27 2025 CQI GOALS ...................................................................................................................................... 27 Appendices A-H APPENDIX A: CONTINUOUS QUALITY IMPROVEMENT (CQI) POLICY ............................................................... 29 APPENDIX B: PUBLIC SAFETY ANSWERING POINT (PSAP) ORGANIZATIONAL FRAMEWORK ............................ 30 APPENDIX C: EMS TELEHEALTH GUIDELINES .............................................................................................. 31 APPENDIX D: QUALITY COUNCIL CHARTER .................................................................................................. 34 APPENDIX E: ELECTRONIC HEALTH RECORD (EHR) POLICY ........................................................................ 35 APPENDIX F: EMS EVENT REPORTING POLICY AND RESOLUTION FORM ....................................................... 38 APPENDIX G: LEAVE BEHIND NARCAN AND FENTANYL TESTING POLICY ....................................................... 40 APPENDIX H: SOCIAL MEDIA MESSAGING CALENDAR ................................................................................... 42 References .................................................................................................................................................... 43 Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 I. Introduction AUTHORITY The Alameda County EMS Continuous Quality Improvement (CQI) Plan satisfies the requirements of Title 22, Division 9, Chapter 12, Article 4 of the California Code of Regulations and Division 2.5, Chapter 4 of the Health and Safety Code.1,2 Additionally, the California Emergency Medical Services Authority (EMSA) resource #166 Emergency Medical Services System Quality Improvement Program Model Guidelines was referenced, ensuring this plan aligns with its recommendations.3 The Alameda County EMS CQI Program operates under the direction of the Local EMS Agency (LEMSA) Medical Director Zita Konik and Deputy Medical Director Alex Schmalz. The Alameda County EMS Agency’s CQI Administrative Policy is included in this plan (Appendix A). Sections 1157 and 1157.7 of the California Evidence Code protect the proceedings of and records of committees evaluating prehospital emergency care quality from discovery.4 This CQI plan was revised on January 29th, 2026, by EMS Coordinator Naila Francies. ALAMEDA COUNTY EMERGENCY MEDICAL SERVICES AGENCY Improving patient health outcomes is at the forefront of the Alameda County EMS Agency’s Continuous Quality Improvement (CQI) program. Our mission is centered on elevating the overall quality of emergency medical services, ensuring each patient receives the best possible care. Emergency Medical Dispatchers (EMD), Basic Life Support (BLS), and Advanced Life Support (ALS) clinicians are often the earliest point of contact in a patient’s health journey and play a pivotal role in influencing a patient’s outcome and chance for survival. The Alameda County CQI Program aims to set new benchmarks for excellence. Our commitment to equitable care drives us to continuously improve and safeguard the health of our community, guided by the Institute for Healthcare Improvement's call to design improvement efforts from the start that are focused, targeted, culturally tailored to meet the needs of marginalized populations.5 CQI is non-punitive and strongly centered in education. Mistakes threatening patient safety are rarely the fault of individuals and far more likely to be natural consequences of poorly designed systems. William Edwards Deming determined, “every system is perfectly designed to get the results it gets.”6 The Alameda County CQI program embodies a Just Culture® defined as “a culture that holds organizations accountable for the systems they design and for how they respond to individual behaviors in fair and just manners.”7 It is our responsibility as the Alameda County EMS Agency to engineer clear policies, recovery strategies, and effective barriers to achieve positive outcomes. This plan serves as a resource for each Alameda County EMS provider’s CQI Plan. All pragmatic improvement plans, and each activity within it, work best when they are simple and focused. Like many CQI plans, this one is designed to address the following questions: Why do we do what we do? What are we doing to improve? see ourselves in the drives our day-to-day decisions? How are we doing? Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 MISSION, VISION, AND VALUES STARCARE Enhancing the overall mission, vision, and values of Alameda County EMS is STARCARE.8 Paramedic educator, Thom Dick, developed this important framework that incorporates key values into the decision-making process for EMS clinicians. This structure is adopted locally with the aim of creating a strong ethically driven practice within the EMS system. 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. Vision Helping people live healthy and fulfilling lives through training, preparedness, prevention, and medical response. afe Were my actions safe for me, for my colleagues, for other professionals and for the public? eam-Based Were my actions taken with due regard for the opinions and feelings of my co-workers, even those from other agencies? ttentive to Human Needs Did I treat my patient as a person? Did I keep them warm? Was I gentle? Did I use their name throughout the call? Did I tell them what to expect in advance? Did I treat their family/relatives with espectful Did I act toward my patient, my colleagues, my first responders, the hospital staff, and the public with the kind of respect that I would have wanted to receive myself? ustomer Accountable If I were face-to-face right now with the customers I dealt with on this response, could I look them in the eye and say, “I did my very best for you.” ppropriate Was my care appropriate medically, professionally, legally, and practically, considering the circumstances I faced? easonable Did my actions make sense? Would a reasonable colleague of my experience have acted similarly under the same circumstances? thical Were my actions fair and honest in every way? Are my answers to these questions honest with integrity? Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 GOALS AND OBJECTIVES The purpose of the Alameda County CQI program is to narrow the gap between performance and expectations with the goal of improving patient outcomes. This plan outlines our commitment to continuously monitor, review, evaluate, and improve the delivery of prehospital care services. We aim to achieve our goal of improving patient outcomes by focusing on the following objectives: Reduce pain and suffering and improve the health outcomes of patients in Alameda County Ensure the delivery of patient care is safe and equitable across all demographics including race, ethnicity, sex, gender, and age Continuously assess system performance through structure, process, and outcome metrics, evaluating alignment with local protocols and their overall effectiveness Create a culture of learning where EMS clinicians feel safe to participate in CQI activities without fear of repercussion, and become the driving force behind system changes Build consensus and jointly design system changes with all EMS stakeholders Utilize data to inform decision-making and apply evidence-based improvement methodologies to implement changes effectively CQI FRAMEWORK This CQI program is built on three core pillars, originally defined by EMS author Craig A. Stroup, which guide our activities: utilizing standardized processes to measure baseline performance (System Evaluation), employing a structured methodology for driving improvement initiatives (Quality Improvement), and maintaining a constant focus on patient health and safety (Patient Safety).9 Sections of this plan addressing these pillars are identified with a small icon next to its corresponding title or heading. Each CQI pillar flourishes in a culture of psychological safety, encouraging active engagement from EMS clinicians: an environment we are working to cultivate. System Evaluation Understanding our system’s baseline performance by collecting data and organizing it into a standardized through key performance indicators. Quality Improvement This is the actual work of making improvements, using science-based methodologies. Each initiative has a clear objective and data to back up why we’re doing it. Patient Safety Preventing patient harm is central to all CQI activities, influencing the first two pillars. We’ve created a reporting process for adverse events and near misses. Sy s t e m Ev a l u a t i o n Sa f e t y CQI Psychological Safey Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 II. Structure, Organizational Description, Responsibilities ALAMEDA COUNTY DEMOGRAPHICS Alameda County is both geographically and demographically diverse. The entire county covers 739 square miles and includes highly dense urban areas; the shoreline of San Francisco Bay is on the western border, low- and high-density residential areas, and a high concentration of industrial sites, and rural, wilderness and parks areas that stretch to the east. More than 1.6 million people live in Alameda County according to the 2025 Census Data.10 The City of Oakland, in the north part of the County, is the largest city with a population of 412,000+. Other large cities include Fremont in the south (210,000+), the City of Hayward in the mid-part of the County (146,000+), and the City of Berkeley in the northern sector of the County (105,000+). Approximately 160,000+ people reside in the cities of Livermore, Dublin and Pleasanton that are located in eastern Alameda County. The vast ethnic, racial, and cultural diversity is a strength of this community. While it is difficult to quantify the number of languages spoken in Alameda County, there are five (5) recognized threshold languages, defined by the California Department of Healthcare Services as ≥3000 speakers per language or ≥5% of the Medi-Cal Population that speak the language per county.11 Locally, these are Chinese (Cantonese and Mandarin), English, Spanish, Tagalog, and Vietnamese. It is important to acknowledge while Cantonese and Mandarin are categorized as one language, we recognize they are two different languages. The contracted 911 ambulance provider, Falck, provides audio and video language interpretation for all EMS providers county-wide, through Language Line Solutions®, offering 200+ languages, including Indigenous languages and American Sign Language. This plan emphasizes our responsibility of collecting and analyzing data through an equity lens, ensuring all members of our community have access to emergency medical services and receive the same level of excellent clinical care. Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 ALAMEDA COUNTY ORGANIZATIONAL CHART Gutierrez Finance Service Specialist II Todd Stephenson Program Specialist Preston Lam Program Specialist Beverly Chu Program Specialist Nmarisaha Berry Program Specialist (Assoc.) Emma Olenberger Program Services Coordinator ↑ Hunter Park Supply Clerk II Clinical Systems of Care Alameda County Board of Supervisors David Haubert, District 1 Elisa Márquez, District 2 Lena Tam, District 3 Nate Miley, District 4 Healthcare Services Agency (HCSA) Acting Director: Aneeka Chaudry Director (OAD) Director: Aneeka Chaudry Health Director: Ronald Browder Health Director: Dr. Karyn Tribble Health Director: Kimi Watkins-Tartt (EMS) Interim Director: Will McClurg Deputy Director: Vacant Leslie Simmons EMS Coordinator Contract Compliance/ BLS Providers/ Hospital Receiving Scott Salter EMS Coordinator Professional Standards Yolanda Takahashi EMS Coordinator Behavioral Health/ CATT/ Dispatch Gerald Takahashi EMS Coordinator Training Programs Victor Pires Data Science Strategic & Specialized Response Jim Morrissey Supervising EMS Coordinator Administrative Support and Finance Erica Campos Supervising Program Specialist HEPR - Health Emergency Preparedness & Response Ron Seitz Supervising Program Injury Prevention Kat Woolbright Supervising Program Specialist EMS Corps Michael Gibson Jr. Senior Program Specialist Mike Jacobs EMS Coordinator Specialty Systems of Care Naila Francies EMS Coordinator CQI/Systems of Care/EHR and Analytics Megan Foy UCSF EMS Fellow Elizabeth Avakoff UCSF EMS Fellow Kreig Harmon EMS Coordinator CQI/Policy Updates Carolina Snypes EMS Coordinator RFP/ Procurement & Contracts (Operations) Cynthia Frankel EMS Coordinator EMSC/Pedi Surge Elsie Kusel EMS Coordinator Specialty Programs/ Preceptor Training Andy Sulyma EMS Coordinator RDMHS/ Dispatch Ryan Preston EMS Coordinator RDMHS/ Hospital Receiving Christina Lee Administrative Specialist II Michelle Barrientos Specialist Clerk II Maria Ramos Specialist Clerk I Lucretia Bobo Community Outreach Worker II Deyante Newson Community Health Outreach Worker II Martha Lemus Clerk II Ysela Jimenez Program Specialist Carol Powers Program Specialist Senior Injury Prevention Laura Fultz Program Specialist Senior Injury Prevention Kim Chung Community Health Outreach Worker II Dr. Zita Konik EMS Medical Director & Supervisor Dr. Alex Schmalz EMS Deputy Medical Director & Operations & Regulatory Compliance Sonya Lee Specialist Clerk I Elise Harris Specialist Clerk I Shant’e Williams Specialist Clerk I Clara Arana Specialist Clerk I Teelee Garvin Specialist Clerk II Alameda County Community See Alameda County EMS Agency Directory for Contact Information Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 EMS SYSTEM STAKEHOLDERS The Alameda County EMS system responds to approximately 160,000 medical emergencies each year and completes approximately 110,000 transports. Within the cities of Alameda, Albany, Berkeley and Piedmont, the ALS fire departments provide ambulance transport services in addition to first response. Outside of these cities, ALS fire departments provide first response units and Falck provides emergency transport services under contract with the County. The Public Safety Answering Point (PSAP) organizational framework is included in this plan (Appendix B). Below is a list of the EMS stakeholders in Alameda County. o Alameda City Fire Department o Albany City Fire Department o Berkeley City Fire Department o Falck Ambulance o Piedmont Fire Department Patients o All PSAP Agencies o Alameda County Regional Emergency Communication Center (ACRECC) o Oakland Fire Department Dispatch Center Telehealth o MD Ally o Tele911 Receiving Facilities o Alameda Health System Highland (Base Designated Hospital) o Alameda Hospital o Alta Bates Medical Center; Berkeley o Alta Bates Medical Center; Summit o Eden Medical Center o John George Pavilion o Kaiser Permanente Fremont o Kaiser Permanente Oakland o Kaiser Permanente San Leandro o San Leandro Hospital o Stanford Healthcare Tri-Valley o UCSF Benioff Children’s Hospital o Washington Hospital o Willow Rock Community Partners o Patient Families o Community Organizations o City Councils o County Board of Supervisors o Education/Training Programs o Vendors o Insurance/Third-Party Providers o Other Regulatory Agencies ALS Fire Departments o Alameda City Fire Department o Alameda County Fire Department o Albany City Fire Department o Berkeley City Fire Department o Piedmont Fire Department o Fremont Fire Department o Hayward Fire Department o Livermore-Pleasanton Fire Department o Oakland Fire Department BLS Fire Departments o Camp Parks Fire Department o East Bay Regional Parks Fire Department Community/Behavioral Health Response Teams o Community Assessment and Transport Team (CATT) o City of Alameda - Community Assessment Response and Engagement (CARE) o Hayward Evaluation and Response Team (HEART) o Mobile Assistance Community Responders of Oakland (MACRO) Air Transport Providers o REACH Interfacility Transport (IFT) Providers o America West Medical Transport o American Medical Response (AMR) o Arcadia o Bay Medic o Eagle o Falck o Falcon CCT o Nor-Cal o Pro Transport-1 o Royal Ambulance o Westmed Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 SPECIALIZED PROGRAMS Behavioral Health System of Care EMS Coordinator, Yolanda Takahashi, oversees activities within the behavioral health system of care, and developed the Community Assessment and Transport Team (CATT). CATT is aimed at addressing the diverse mental health needs of our community without relying solely on traditional 911 EMS or emergency department resources. Various programs work collaboratively within the system to provide crisis responses and community support, such as the Mobile Assistance Community Responders of Oakland (MACRO), operated by the Oakland Fire Department, The Community Assessment Response & Engagement (CARE) team is led by the Alameda Fire Department, and the Hayward Evaluation and Response Team (HEART) which is a cross departmental program between Hayward City Manager’s Office, Police and Fire Department. Critical Care Paramedic (CCP) Program The Alameda County EMS Agency and San Francisco County EMS Agency had previously collaborated to design CCP protocols, expanding the scope of practice, and established CCP accreditation and reciprocity. AMR, which had been the provider of critical care paramedics, recently ceased operations in Alameda County and is now considering reintroducing the program in 2025. EMS for Children (EMSC) System of Care EMS Coordinator, Cynthia Frankel, oversees EMSC QI activities; see the EMSC System Plan. High 911 Utilizers EMS Coordinator Elsie Kusel facilitates cross-agency collaboration among public health, social services, receiving centers, and EMS organizations to identify frequent 911 callers and connect them with comprehensive "wrap-around" services or social resources. Injury Prevention Program Manager Kat Woolbright leads the Injury Prevention Program, aimed at reducing unintentional injuries and fatalities, focusing on individuals under the age of 18 and over 60. Substance Use Disorder (SUD) EMS Deputy Medical Directory Alex Schmalz and EM Coordinator Carolina Snypes oversees opioid safety programs, and works closely with Alameda County Public Health on local efforts. Sexual Assault and Domestic Violence (DV) This is an evolving system of care. EMS Medical Director Dr. Zita Konik and EMS Coordinator and Naila Francies, oversee data collection and EMS education related to sexual assault and domestic violence. EMS Coordinator Elsie Kusel serves on the Alameda County Death Review Committee for victims of domestic violence and implemented a DV fatality screening process for EMS. ST Elevation Myocardial Infarction (STEMI) & Cardiac Arrest Systems of Care EMS Coordinator Naila Francies oversees activities related to STEMI, and EMS Coordinator Michael Jacobs oversees activities related to Cardiac Arrest. Refer to the STEMI System Plan for quality improvement efforts for these systems of care. Stroke System of Care EMS Coordinator Naila Francies oversees activities related to Stroke; see the Stroke System Plan. Telehealth Falck and the Hayward Fire Department (HFD) utilize different versions of telehealth for low acuity patients who may be better served by resources offered outside of the Emergency Department. MD Ally is used by Falck, and Tele911 is used by HFD. These programs have not been integrated into dispatch centers, which is where they have the highest potential to limit the demand on the 9-1-1 system. The EMS Telehealth Guidelines policy is attached in this plan (Appendix C). Trauma System of Care EMS Coordinator Kreig Harmon oversees activities related to Trauma; see the Trauma System Plan. Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 QUALITY IMPROVEMENT RESPONSIBILITIES: GENERAL GUIDELINES I. Regulatory Compliance and Oversight a. The Alameda County EMS Agency, Base Hospital, and all EMS clinician organizations within Alameda County shall comply with EMS statues and regulations pursuant to Title 22, Division 9, Chapter 12, Article 4 of the California Code of Regulations.1 II. CQI Program Evaluation and Monitoring a. Each CQI program should be designed to prevent potential deficiencies (prospective), have a mechanism to identify issues in real time (concurrent), and identify and prevent reoccurrence of deficiencies through quality improvement initiatives (retrospective). b. All CQI activities will be shared with the EMS Agency to ensure that insights gained can guide improvements to enhance system design. c. The Base hospital, and all EMS clinician organizations, are strongly encouraged to review quality improvement indicators through an equity lens, considering disaggregation by race/ethnicity and sex to better understand and address potential disparities in patient care outcomes. QUALITY IMPROVEMENT RESPONSIBILITIES: ALAMEDA COUNTY EMS AGENCY I. Alameda County EMS Agency Core CQI Functions a. Establish and facilitate a system wide quality improvement program to monitor, review, evaluate and improve the delivery of prehospital care services b. Design retrospective reports and analytics to monitor trends in pre-hospital and hospital system performance and share these analytics system-wide through quality-improvement meetings c. Evaluate performance through the lens of equity and inclusion; disaggregating data by age, race/ethnicity, and sex d. Evaluate and approve and the base hospital, and all EMS provider’s CQI plans e. Approve and monitor prehospital training programs f. Certification of Public-Safety First Aid personnel (PSFAs), Emergency Medical Technicians (EMTs), Emergency Medical Dispatchers (EMD), and local accreditation of Paramedics. i. Track when providers are newly hired or released from employment amongst EMS service provider organizations. g. Provide prospective system-wide direction through established county policies, field treatment guidelines and procedures h. Develop and implement policy changes and organize annual EMS policy updates for the system i. Coordinate with EMS system stakeholders for site visits and/or ride-alongs j. Review and investigate all EMS Event Reporting forms and take appropriate action, sharing final resolutions with involved parties Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 QUALITY IMPROVEMENT RESPONSIBILITIES: DISPATCH COMMUNICATION CENTERS I. Dispatch Communication Centers Core CQI Functions a. Participation in quality improvement meetings and committees as specified by the Alameda County EMS Agency. Collaborate with the EMS Agency, hospitals, and other provider agencies on Quality Improvement initiatives b. Continuing education to further the knowledge base of EMS clinicians based on available data and trend analysis c. Develop structure, process, and outcome measures for monitoring performance d. Utilize retrospective analysis to identify trends in EMD performance i. Prioritizing a system-level analysis for quality improvement (QI) and conduct a sample quality assurance (QA) review of wave files ii. Utilize audio recording or dispatcher report form, including any call requested to be reviewed by EMS or other appropriate agency e. Develop a process for addressing and correcting system deficiencies f. Evaluate EMDs through direct observation, including new employee evaluations g. Establish an efficient process for disseminating system changes to EMD providers h. Oversee and monitor EMD training for initial certification and renewal processes QUALITY IMPROVEMENT RESPONSIBILITIES: EMS CLINICIAN AGENCIES I. EMS Clinician Agencies Core CQI Functions a. Participation in quality improvement meetings and committees as specified by the Alameda County EMS Agency. Collaborate with the EMS Agency, hospitals, and other provider agencies on Quality Improvement initiatives. b. Continuing education to further the knowledge base of EMS clinicians based on available data and trend analysis c. Develop structure, process, and outcome measures for monitoring performance d. Utilize retrospective analysis to identify trends in EMS performance i. Prioritizing system analysis for quality improvement (QI) rather than individual review for quality assurance (QA). ii. Case reviews as requested by the Alameda County EMS Agency e. Develop a process for addressing and correcting system deficiencies f. Evaluate EMS clinicians through direct observation, e.g., ride-alongs, including new employee evaluations g. Establish an efficient process for disseminating system changes to EMS clinicians h. Establish a system to maintain current records applicable to clinicians including: i. California State Paramedic License or EMT Certification ii. Local paramedic accreditation iii. AHA equivalent Basic Cardiac Life Support (BCLS) iv. AHA equivalent Advanced Cardiac Life Support (ACLS) v. AHA equivalent Pediatric Advanced Life Support (PALS) vi. International Trauma Life Support (ITLS) or Prehospital Trauma Life Support (PHTLS) vii. Field Training and Evaluation process viii. Annual Policy Updates Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 QUALITY IMPROVEMENT RESPONSIBILITIES: ALS BASE HOSPITAL I. ALS Base Hospital Core CQI Functions a. An ALS Base Hospital is a hospital designated by the Alameda County Emergency Medical Services Agency and has all following: i. A written contractual agreement with the Alameda County EMS Agency ii. Primary responsibility for the direct, online medical control of EMS calls received from the field. b. The Base Hospital shall agree to: i. Utilize voice communications and be available to EMS clinicians through a consistent channel, frequency, or telephone number twenty-four (24) hours a day, three hundred sixty-five (365) days a year. ii. Provide physician response with sixty (60) seconds of receipt of call. Physician orders and consultation shall be provided directly by the physician. iii. Initiate a Base Hospital Contact Form completed by the Base Hospital Coordinator each time that the Base Hospital is contacted by and EMS clinician. iv. The Base Hospital Contact Form is considered a medical record and must comply with all criteria outlined in the California Code of Regulations, Title 22, § 72543.12 In the event of a technological failure, data should be documented in written form or an equivalent method and then transferred to the online form once the system is restored. v. The Base Hospital Contact Form should collect all the following data when available, including but not limited to: 1. Incident date & time 2. EMS incident number 3. EMS agency/organization name 4. EMS unit identifier 5. Patient demographics 6. History of present illness and/or injury 7. Vital signs 8. Reason for EMS contacting base 9. Final physician disposition and/or orders 10. Record all communications between the Base Hospital and EMS clinicians vi. Recordings are considered to be part of the patient’s medical record and shall be retained for 7 years pursuant to the California Code of Regulations, Title 22, § 72543. 12 1. Recordings may be used for educational purposes within the Alameda County EMS system, provided that all identifiable information is de- identified to protect privacy. 2. The Base Hospital shall provide any recording requested by the Alameda County EMS Agency. vii. Comply with all prehospital standards, protocols, policies, procedures, and contracts set by the County Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 QUALITY IMPROVEMENT MEETINGS The Alameda County EMS Agency facilitates numerous quality improvement-centered meetings with system partners, to continue fostering collaboration and jointly design system-changes. Each meeting will have several EMS agency representatives including the EMS medical director and deputy medical director in attendance when possible. Ad hoc meetings are formed as needed and have previously included APOT, Equipment and Supplies, and Policy Workgroups, which are not included in the below list. All listed meetings are externally focused, detailing their frequency, facilitators, and purpose. Base Tape Review a. Facilitation: Monthly - Kreig Harmon, EMS Coordinator b. Purpose: Highland Base Hospital coordinates EMS cases to review for QA/QI prior to Quality Council Basic Life Support (BLS) Provider Meeting a. Facilitation: Quarterly - Leslie Simmons, EMS Coordinator b. Purpose: System evaluation/coordination for IFT providers permitted to operate in Alameda County Cardiac Arrest System of Care a. Facilitation: May/December - Mike Jacobs, EMS Coordinator b. Purpose: Presenting both prehospital/hospital performance data for acute STEMI patients, develop change ideas, shorten time to definitive treatment, and share best practices and new research Data Steering Committee a. Facilitation: Quarterly - Naila Francies, EMS Coordinator b. Purpose: Ensuring configuration consistency across all provider instances of ESO, compliance with timely CEMSIS data submission, improving methods of capturing clinically significant data EMS for Children (EMSC) System of Care a. Facilitation: May/November - Cynthia Frankel, EMS Coordinator b. Purpose: Coordinates quality improvement initiative with hospital and prehospital providers Medical Dispatch Review Committee (MDRC) a. Facilitation: Quarterly - Andy Sulyma, RDMHS b. Purpose: Clinical/operational coordination between the ACRECC, OFD, Falck, and the EMS Agency. Quality Council (Appendix D: Quality Council Charter) a. Facilitation: Monthly - Kreig Harmon, EMS Coordinator b. Purpose: Advisory group to the Alameda County EMS Agency, identifies QI needs, present prehospital/hospital performance data, and is a ‘catch-all’ meeting for clinical or operational system challenges. The goal is to unify all stakeholders within the EMS system. Receiving Hospital Committee a. Facilitation: Quarterly - Leslie Simmons, EMS Coordinator & Ryan Preston, RDMHS b. Purpose: Advisory group for Hospital and ED leadership, prehospital agencies, and Alameda County EMS to discuss relevant system issues, identify areas for improvement, and review policy changes STEMI System of Care a. Facilitation: April/August/November - Naila Francies, EMS Coordinator b. Purpose: Prehospital/hospital performance data, develop change ideas, drive improvement Stroke System of Care a. Facilitation: April/August/November - Naila Francies, EMS Coordinator b. Purpose: Prehospital/hospital performance data, develop change ideas, drive improvement Trauma Advisory Committee (TAC) a. Facilitation: Quarterly - Kreig Harmon, EMS Coordinator b. Purpose: Advisory group and regional coordination of trauma systems of care between Alameda and Contra Costa counties, includes LEMSA, receiving center, and prehospital clinician participation Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 III. Data Collection and Reporting EMS DATABASES AND ANALYTIC PLATFORMS Accurate data collection is essential for CQI activities and hinges on valid documentation at the key entry point. All ALS prehospital organizations in Alameda County use ESO as their Electronic Health Record (EHR), which is compliant with National EMS Information System (NEMSIS) Version 3.5.0 standards. ESO data is exported directly from provider agencies to the California EMS Information System (CEMSIS), and the Alameda County EMS Agency uses an ESO “umbrella” account to view these records.13,14 The Alameda County Electronic Health Record (EHR) Administrative Policy is included in this plan (Appendix E). Efforts to integrate data among dispatch centers, prehospital providers, receiving facilities, and community partners is ongoing. Access to hospital and prehospital data systems enables impactful quality improvement initiatives and research. Online surveys have been an effective method for gathering feedback from local EMS clinicians. An annual survey is conducted ahead of each protocol update training to capture field insights on key system topics. The Alameda County EMS Agency also utilizes advanced analytics platforms for comprehensive data analysis, managed by Naila Francies, Will McClurg, and Victor Pires. Healthcare Data Exchange (HDE) facilitates sharing of patient outcomes and physician notes between several receiving centers and ALS providers using ESO. Registries are used for specialty services, enhancing data collection and quality improvement efforts. Emergency Medical Dispatch (EMD) Communication Centers Computer Aided Dispatch (CAD) Priority Dispatch System/ProQA Center of Excellence (ACE) Academy Analytics Hexagon Yes Yes Yes Motorola P1 Yes Yes Yes Arrest Registry Registry Registry Epic Yes CARES GWTG-CAD GWTG-Stroke Trauma One Epic Yes CARES N/A GWTG-Stroke N/A Epic Pending CARES N/A N/A N/A Epic Pending CARES GWTG-CAD GWTG-Stroke N/A Epic Yes CARES N/A N/A Trauma One Epic Pending CARES N/A GWTG-Stroke Trauma One Epic Yes N/A N/A N/A N/A Epic Pending CARES GWTG-CAD GWTG-Stroke N/A Epic Pending CARES GWTG-CAD GWTG-Stroke N/A Epic Pending CARES N/A GWTG-Stroke N/A Epic Yes CARES N/A N/A N/A Meditech Yes CARES GWTG-CAD N/A N/A Epic Yes CARES GWTG-CAD GWTG-Stroke N/A Epic Yes CARES GWTG-CAD GWTG-Stroke Patient Registry (ESO) Unknown No N/A N/A N/A N/A Data Sources Cardiac Arrest Registry to Enhance Survival (CARES) ESO First Watch/First Pass, Academy Analytics Get With The Guidelines (GWTG) Stroke & Coronary Artery Disease (CAD) Healthcare Data Exchange (HDE) ImageTrend License Management System ReddiNet Surveys Ad Hoc (Microsoft Forms or Smartsheet) Trauma One Analytic Platforms ESO Insights Microsoft Excel/QI Macros Microsoft Power BI Tableau Python R Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Prehospital Provider Agencies EHR HDE Cardiac Arrest Registry Watch/ First Pass ESO Yes CARES Yes ESO Yes Pending Yes ESO Yes CARES Yes iPCR No Pending No ImageTrend No N/A No TBD No N/A No TraumaSoft No N/A Yes ESO Yes CARES Yes Unknown No N/A No ESO No N/A Yes ESO No N/A Yes TraumaSoft No N/A No ESO No N/A Yes ESO Yes CARES Yes TraumaSoft No N/A Yes ESO Yes Pending Yes ESO Yes Pending Yes ESO Yes Pending Yes ESO No N/A Yes TraumaSoft No N/A Yes ESO Yes Pending Yes ESO Yes CARES Yes Unknown No N/A No TraumaSoft No N/A Yes Zoll No N/A Yes *All EHRs are required to comply with the most current NEMSIS and CEMSIS standards EMS EVENT REPORTING Previously known as an Unusual Occurrence (UO), EMS Event Reporting establishes minimum standards for notifying the LEMSA of significant events and provides a structured process for feedback. These reports are critical for identifying system issues, particularly patient safety matters, and rely on transparent self-reporting. EMS Coordinator Yolanda Takahashi facilitates biweekly internal meetings to work through events, coordinate efforts in cases of overlap, and identify trends. This internal review process adheres to the principles of the Just Culture® framework. Event categories include clinical or operational issues, suspected human trafficking, and exemplary EMS care. Clinical and operational events are managed by EMS coordinators under EMS agency leadership. Suspected human trafficking events are managed by EMS Coordinator Naila Francies, reporting these to the Northern California Regional Intelligence Center (NCRIC) within 24 hours of receiving the event.15 Exemplary EMS care events are managed by EMS Coordinator Carolina Snypes, who may offer official commendations or recognition. The EMS Event Reporting Form is a Smartsheet-based form available through the local protocol application under the "References" section or on the Alameda County EMS website homepage under "Reports." Submitted reports instantly alert Alameda County EMS leadership and coordinators, depending on the event category (e.g., clinical, operational). The Deputy Director or Deputy Medical Director assigns a lead reviewer to each event, aligning assignments with the reviewer’s program area and expertise. Each event is expected to be resolved within sixty (60) days, including the delivery of written resolutions to the appropriate reporting parties. Anonymous reporting is available; in such cases, event resolutions are often unable to be communicated. The Alameda County EMS Event Reporting Policy and Resolution Form are included in this plan (Appendix F). The event reporting form is specially designed for EMS system providers, while a separate form for the public to report concerns is accessible on the homepage. We have created a public-facing dashboard on the Alameda County EMS Agency website that summarizes EMS event report volumes, categories, and reporting sources. Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 IV. Evaluation of Indicators SYSTEM EVALUATION PRINCIPLES What is not measured cannot be managed. Indicators, metrics, and measures are terms used interchangeably in this plan describing the same thing; they are visuals telling us how our system is doing. The purpose of organizing data into standardized formats is to create easily understandable visualizations identifying strong performance and opportunities for change. Local indicators are used to drive data-informed decision-making and steer quality improvement efforts. Improvement initiatives will only be implemented when they are supported by valid data reinforcing their necessity. The primary approach utilized in this plan is system-wide Quality Improvement (QI), evaluating performance over time on a monthly, quarterly, or annual basis. Data is shared primarily through control charts, run/line charts, bar charts, box plots, and pareto charts. Visualizing measures over time is one of the most impactful ways to present data. Conducting a complete 100% Quality Assurance (QA) audit of individual EHRs is not an efficient approach to analyzing data or driving systemic change. This method is more suited for smaller organizations or scenarios where it is the only viable option for gathering essential information. The Alameda County EMS Agency mostly reserves QA for random sampling of individual charts to understand the “why” behind an issue or trend. Insights from the narrative can offer a unique perspective, while direct consultations with clinicians may uncover important nuances that might not be reflected in the EHR narrative or fields. Our metrics are organized in three ways: structure is the least impactful, process is the most frequently used, and outcome is the most critical. Balancing measures can be organized in either of these ways and ensures changes to one area does not result in problems in another. For example, achieving 100% first-pass intubation success rates can be detrimental if it leads to a decrease in overall cardiac arrest survival rates. CALIFORNIA EMS CORE QUALITY MEASURES Alameda County has participated in the California Core Measures Project since 2010.16 The measures below are submitted annually to the California Emergency Medical Services Authority (EMSA) before the standard deadline at the end of March by EMS Coordinator Naila Francies. Below is the data submitted for the year 2024. Additionally, EMSA is piloting five (5) new measures aligned with NEMSQA that may be incorporated into the 2025 Core Measures submission. These metrics are still under review by the state and LEMSAs to ensure they are meaningful measures and collected in a way that is both valid and reliable. Measure ID # Measure Name Populations Numerator Value (Subpopulation) Denominator Value (Population) Reported Value (%) TRA-2 Transport of Trauma Patients to a Trauma Center P1: Pediatric Patients 112 124 90% P2: Adult Patients 2737 2893 95% HYP-1 Treatment Administered for Hypoglycemia P1: Pediatric Patients 8 35 23% P2: Adult Patients 1688 3159 53% STR-1 Prehospital Screening for Suspected Stroke Patients Pediatric and Adult Patients 3630 3630 100% PED-3 Respiratory Assessment for Pediatric Patients Pediatric Patients Only 524 604 87% Structure “Things” within a system # of Cardiac Arrest where the initial rhythm is shockable Process “Activities” within a system % of bystander CPR or AED performed for all Cardiac Arrests Outcome “Results” of a system % of neurologically intact survival How much do we do? How well do we do it? Is anyone better off? Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 ALAMEDA COUNTY EMS AGENCY INDICATORS Under the guidance of the Alameda County EMS Medical Director, and Deputy Medical Director, these metrics were developed collaboratively to assess system-wide performance. These metrics are reported to the EMS system at least twice a year through various Quality Improvement meetings. Excluding ad hoc measures for short-term projects, these indicators are designed to evolve continually. A significant challenge remains in effectively communicating the insights from these indicators back to the EMS clinicians. In a large system, achieving consistent field provider representation at QI meetings is difficult, and identifying the most effective method to share this data with them is an ongoing effort. Metrics identified with a are disaggregated by race and sex to assess for equitable care delivery. Locally we mandate the collection of patient race—excluding "unknown" as an option—and resident status (homeless or not) for every patient contact. Category/ Area Apart from structure metrics, the indicators below are calculated as percentages to reflect “n” Metric Type Source Completed infrequent skills for paramedics (Proposed for Q3 2025) Process ImageTrend (2) Equipment and Supplies Vehicles Completed biennial ambulance inspections (Proposed for Q4 2025) Process ImageTrend (3) Documentation Electronic Health EHR) Successful export of data in CEMSIS/NEMSIS Outcome ESO EHR Locked within ≤ 72 Hours of Incident Creation Date Process ESO (4) Clinical Care and Patient Outcomes Stroke Blood Glucose Level - Stroke Alerts Process ESO Last Known Well Time - Stroke Alerts Process ESO Stroke Screening Documented - Stroke Alerts Process ESO Stroke Alerts Transported to a Stroke Receiving Center Process ESO Response/Scene/Transport Time (90th Percentile): Stroke Alerts Process ESO Arrival by EMS - Stroke Activations Receiving Thrombolytics Process GWTG Door-to-CT Time (90th Percentile) Process GWTG CT-to-Needle Time (90th Percentile) Process GWTG Door-to-Needle Time (90th Percentile) Process GWTG Dispatched Time-to-Needle Time (90th Percentile) Process ESO/GWTG Door-In-Door-Out Time for Large Vessel Occlusion (90th Pctile) Process GWTG STEMI/Acute Coronary Syndrome (ACS) ASA Administration - STEMI Alerts Process ESO STEMI Alerts Transported to STEMI Receiving Centers Process ESO Response/Scene/Transport Time (90th Percentile): STEMI Alerts Process ESO Arrival by EMS - STEMI Activations Receiving PCI Process ESO Mission Lifeline 12-lead ECG in ≤10 min for STEMI patients Outcome ESO Process GWTG Cath Lab-to-PCI Time (90th Percentile) Process GWTG Door-to-PCI Time (90th Percentile) Process GWTG Dispatched Time-to-PCI Time (90th Percentile) Process ESO/GWTG Cardiac Arrest (Non-Traumatic) Double Sequential Defibrillation when indicated Process ESO Admitted to Hospital Process CARES Neurologically Intact Survival - (CPC 1-2) Outcome CARES Overall Survival - (CPC 1-4); Alameda County & National Outcome CARES Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Cardiac Arrest (Non-Traumatic) Survival - Utstein 1; Alameda County & National Outcome CARES Survival - Utstein 2; Alameda County & National Outcome CARES Transports vs. Field Pronouncements Process CARES Use of LUCAS or Mechanical Compression Device Process CARES ETC02 Use During Cardiac Arrest Resuscitation Process ESO Trauma Scene Time (90th Percentile) - Trauma Alerts Process ESO Scene Time ≤ 10 Minutes & ≤ 20 Minutes Process ESO Trauma Alert for Trauma Patients (Trauma Triage Criteria) Process ESO Transport to a Trauma Receiving Center (Trauma Triage Criteria) Process ESO ETC02 Usage - Trauma Alerts Process ESO Oxygen Administration for Hypoxia - Trauma Alerts Process ESO Pronounced arrests meeting determination of death criteria Process ESO Pediatrics Accuracy of Pediatric Medication Administration Process ESO (100% QA) Pediatape Color Documented for Patients Receiving Medication Process ESO Non-Traumatic Cardiac Arrest Survival - (CPC 1-4) Outcome CARES Non-Traumatic Cardiac Arrest Hospital Admissions Process CARES Respiratory Assessment for Respiratory Distress Process ESO Albuterol Administration for Bronchospasm Process ESO Supraglottic Airway Device - i-GEL Success Rates Process ESO Scene Time (90th Percentile) - Trauma Alerts Process ESO Pediatric Trauma Alerts Transported to Pediatric Trauma Centers Process ESO Fentanyl Administered for Pain ≥ 7 Process ESO Treatment Administered for Hypoglycemia Process ESO Blood Pressure Assessment for Patients ≤ 3 years of age Process ESO Pain Relief Treatment of pain ≥7 on the pain scale Process ESO Sexual Assault Transport to a designated Sexual Assault Receiving Center Process ESO Annual volume of patients experiencing sexual assault Structure ESO (5) Skills Maintenance/Competency Advanced Airway Orotracheal Intubation Success - First Pass Process ESO Supraglottic Airway Device Success - First Pass Process ESO ETC02 with Orotracheal Intubation & Supraglottic Airway Devices Process ESO Cormack Lehane Documentation for Orotracheal Intubation Process ESO (6) Transportation/Facilities Ambulance Patient Offload Time APOT-1: 90th Percentile Time Process First Watch APOT-2: % of offloads ≤ 20 minutes, Process First Watch Arrest Bystander CPR Process CARES Bystander AED Usage Process CARES Opioid Safety Distributed Leave-Behind Narcan Kits Structure ESO (8) Risk Management Care Refusal Against Medical Advice (AMA) vs. Transports Outcome ESO Language Use of Language Interpreter Services for patient with LEP Outcome ESO Opioid Safety Clinical Opiate Withdrawal Scale ≥ 7 with Buprenorphine Process ESO Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Interpreting Indicators EMS PROVIDER AGENCY, DISPATCH, AND BASE HOSPITAL INDICATORS Each EMS provider agency, dispatch communications center, and base hospital is responsible for developing a CQI plan to monitor internal indicators and perform quality improvement activities pursuant to Title 22, Division 9, Chapter 12, Article 4 of the California Code of Regulations.1 Quality improvement indicators are not exclusive to clinical performance and should include operational metrics as well. We encourage provider agencies, dispatch centers, and the base hospital to avoid focusing on structure metrics (volume) and instead place emphasis on process and outcome measures, visualizing these analytics over time. Process and outcome metrics typically involve calculating a ratio, such as the total number of patients with a STEMI-positive 12-lead ECG who received aspirin (numerator) divided by the total number of patients with a STEMI-positive 12-lead ECG (denominator). These metrics can also assess time-based performance, such as scene times in the 90th percentile for patients with a STEMI-positive 12-lead ECG. Since established benchmarks in EMS are limited, each organization should develop their own performance goals to drive improvement. Pareto Chart 80/20 Rule: most critical areas. The first 6 columns in pink add up to 798. Divide that by the “n” (1000), that equals 79.8%. Those 6 pink columns make up 80% of the data. Control Chart plotting data points within control limits, making it easier to identify process being out of control. Points common cause variation (stable reflect special cause variation (unstable variance).17 The upper and lower control limits (UCL & LCL) are 3 standard deviations (σ) above and below the mean. These limits adjust based on the sample size, which may vary across different time periods. Run charts & line charts do not have upper or lower control limits. ≥6 consecutive points above or below the middle line ≥5 consecutive points in one direction Box Plot ◦ The box is where the middle 50% of the data lies. ◦ The lower end of the box is the 1st Quartile (Q1)/25th Percentile, and ◦ the upper end is the 3rd Quartile (Q3)/75th Percentile. ◦ Q3 minus Q1 equals the interquartile range (IQR). In the boxplot, the ◦ solid line is the Median/50th Percentile, and the dashed line is the ◦ mean/average. ◦ The T-shaped whiskers go to the last point, which is within 1.5 times ◦ the interquartile range. Points that are further away outliers. ◦ Outlier = Q1-1.5(IQR) & Q3+1.5(IQR). N=1000 79.8% Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Optional Quality Indicators EMS provider agencies, dispatch centers, and the base hospital must have a QI plan that includes at least one metric from each of the categories below. Using this table of metrics is optional and is intended as a resource. Each local organization will develop metrics tailored to their specific needs. Indicators should be calculated as a percentage representing performance rather than volume. Category* BLS Transport (IFT) Transport (911) (911) Transport (911) Personnel certifications in completed for new in completed for new in completed for new in completed for new check in completed for new hires Equipment and Supplies Daily rig/equipment inspection complete inspection complete inspection complete inspection complete of back up comms back up comms Documentation EHR closed in ≤72 EHR closed in ≤72 EHR closed in ≤72 EHR closed in ≤72 cards share with dispatchers every month, quarter, etc. Hospital Report Forms with an on scene with an on scene time an on scene time an on scene time hospital characters for all patient contacts characters for all patient contacts Clinical Care and Patient Outcomes 2 sets of vital signs for every transport every patient contact 2 sets of vitals every transport every patient contact question documented for every patient patient administration accuracy based on administration accuracy based on determinant chosen given by MD/RN, adherence to alco (BGL) for altered (BGL) for altered administration for administration for administration for seconds O2 administered for SP02 <94%O2 administered for SP02 <94% each patient contact impression of patients transported Primary Impressions arrival CPR contact to first Scene times ≤10 min for Stroke, STEMI, and contact to first pre-arrival Skills Use of interpreter services for patients with language services for patients with language services for patients with language services for patients with language services for callers with services for patients with language barriers optional skills if applicable optional skills if applicable optional skills if optional skills if annually for each dispatcher Transport/Facilities Vehicle maintenance Vehicle maintenance Vehicle maintenance Vehicle maintenance 90th percentile from time call received to dispatching units destination, guidance, ama, trauma alert % of oncollisions % of on % of on % of on Public Education Hands-only CPR Hands-only CPR Hands-only CPR Hands-only CPR Hands-only CPR Hands-only CPR Stop-the Bleed Stop-the Bleed Stop-the Bleed Stop-the Bleed Stop-the Bleed Stop-the Bleed Leave-behind Narcan Leave-behind Narcan Leave-behind Narcan Leave-behind Narcan Leave-behind Narcan Community Health screenings Customer complaints Customer complaints Customer complaints Customer complaints Customer complaints Customer complaints Employee satisfaction satisfaction satisfaction % of AMAs/RAS % of AMAs/RAS Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 V. Action to Improve IMPROVEMENT METHODOLOGY Every quality improvement initiative requires two key elements: a clear objective and data to justify the need for action. While various models exist for quality improvement, it is essential to follow a methodology that is evidence-based. The Alameda County EMS Agency adopts the Institute for Healthcare Improvement (IHI) Model for Improvement, in conjunction with driver diagrams, as the preferred methodology.18 Driver diagrams ensure that each change idea is intentionally crafted to support efforts aligned with the overall aim, guiding initiatives toward meaningful and measurable outcomes. QI projects should be jointly designed with all stakeholders who will be affected by it. Diversity of thought is essential, and people are more likely to support ideas they help create.19 Effective aim statements are built on valid data, ensuring progress remains measurable. Multiple metrics may be used to track advancements towards the aim. Using a driver diagram ensures that each section of the improvement process connects logically, begins with the goal, and ends with the change idea. Not every change idea needs a Plan, Do, Study, Act (PDSA) cycle. When deciding what to test, the priority is to identify changes most likely to lead to an improvement. From there we focus on attainable changes with the greatest potential for impact. When measuring change, we asses balancing metrics to ensure change ideas don’t create new issues elsewhere. See Alameda County EMS QI Resource Page. DO Carry out the tests and collect Collect and analyze the data, summarize what Who does what, where, and when. Develop a data collection plan, and date to complete the Adopt: keep changes. Adapt: modify and run another PDSA cycle. Abandon: discard Institute for Healthcare Improvement (IHI) Model for Improvement Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Ishikawa or "fishbone" diagrams identify root causes of deficiencies and can help kickstart a new project. This tool creates a detailed list of problems contributing to the deficiency. Using the fishbone diagram is optional and can be done prior to developing a driver diagram. It is important to recognize that fishbone diagrams create an in-depth understanding of the problem rather than drive actionable change. The fishbone diagram analyzes what’s wrong and why, while the driver diagram takes a proactive approach, defining the desired outcome and outlining a strategy to achieving it. For this reason, the driver diagram is the preferred tool for all QI initiatives. Step-by-Step Process: Improvement Methodology 1) Pull baseline data to show that a deficiency exists 2) Optional: fishbone diagram to identify root causes leading to the deficiency 3) Begin drafting a driver diagram by first establishing a SMART Aim with all stakeholders 4) Create indicators for measuring efforts towards reaching the Aim; consider your balancing metrics 5) Brainstorm Change Ideas with all stakeholders (do not get attached to one idea, dream big) 6) Work backwards and fill in the Secondary Drivers, then Primary Drivers (it’s easier this way) 7) Ensure each connected sections flows logically as a sentence, following the prompts above it 8) Complete PDSA cycles for appropriate changes; adopt, adapt, or abandon change ideas 9) Measure continuously IMPROVEMENT PITFALLS The least effective approach to driving change is a Personal Improvement Plan (PIP), which targets individuals rather than the system. We discourage the use of PIPs as individuals are rarely the cause of the problem; between 80-90% of issues within any industry are caused by flaws in the system rather than the people.20 Individual coaching has its place, allowing EMS clinicians to share their perspectives and uncover the “why” behind an issue. PIPs are closely aligned with Quality Assurance (QA) which cannot effectively drive systemic change. The table below illustrates the key differences between QA and QI in EMS; a distinction that is fundamental to this plan. If made an error, they are solely responsible and only they should receive corrective action, coaching, or a PIP have made similar errors so we should educate every one one clinicianmedication error all cliniciansadministration best practices, and 100% case auditcaptures a single patient at a single point in time trends over time;the system getting better, worse, or staying the same? one EHRclinician took a blood sugar, documented a LKWT, established ≤10min LKWT, successful IVs, and Scene Times ≤10 min, for every patient over the last several years individual cliniciansright protocols system processesensuring alignment with system expectations through metrics Individual goal settingImprovement Pitfalls about avoiding PIPs ) System-wide goalimproving patient outcomes smaller samplespossible due to report writing or technological limitations larger samples of data (N≥30) Ishikawa “Fishbone” Diagram (Cause and Effect) vs Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 PURSUING HEALTH EQUITY WITH IMPROVEMENT SCIENCE As stated by the National Association of EMS Physicians (NAEMSP), "there is no quality without equity."5 It would be disingenuous to limit our commitment towards advancing equitable care through a CQI framework to one page; our continuous efforts are embedded throughout this plan (see pages 3, 5, 6, 10, 17, 18, and 26). We are in the early stages of developing impactful solutions to address identified disparities while also celebrating progress where disparities are not found. This section will continue to evolve and expand. Managing Data Barriers Data is used to inform our decisions and assess for disparities objectively. However, several nuances in prehospital data collection deserve mention. Race and gender data are typically provider-identified rather than patient-reported. Ethnicity is an optional field, and not regularly collected. As of November 2024, Middle Eastern became a new addition to the race category.21 As of October 2024, NEMSIS v3.5.0 introduced transgender options, however sex assigned at birth and gender identity continue to be conflated in NEMSIS. Alameda County requires collection of Resident Status to identify individuals as ‘Homeless’ or ‘Not Homeless,’ however homelessness is undefined, leaving this field subjective and based on provider observation or patient address reporting. Factors contributing to inequity beyond race and gender are predominantly collected from narratives, including transgender identity (pre-October 2024), domestic violence, strangulation, and sexual assault. While the NEMSIS element eInjury.01 Cause of Injury, includes sexual assault as a category, it is insufficient to capture all cases that EMS may encounter. EMS Medical Director Dr. Zita Konik leads efforts to expand CEMSIS Primary and Secondary Impressions to include sexual assault, domestic violence, and human trafficking. In August 2024, Falck Ambulance upgraded interpreter services to include video functionality for all county EMS providers. While barriers to care due to language are recorded, there is no field to identify a patient’s preferred language or the use of interpreter services. Similarly, collecting data on patients who use mobility aids or have physical or intellectual disabilities is an ongoing challenge. To address these gaps, we rely on data mining narrative documentation to supplement existing fields or when no fields exist. Visualizing Intersectional Data Before taking action, it is vital to assess for disparities at the local level first. Sharing the experiences of intersectional identities in EMS data is challenging but essential for ensuring an inclusive narrative. Data analytics should be straightforward and accessible, allowing for easy interpretation without the need for advanced analytic skills. The University of North Carolina created a data visualization guide for advancing equity, which was used to develop this CPR bubble chart.23 There is a difference between statistical, clinical, and social significance when analyzing data in the context of equity. This chart does not assess for statistical significance between social identities of who is receiving bystander CPR in Alameda County, but it does suggest the need for deeper analysis. Important Terms Affinity Bias: Favoring people who are similar to ourselves in appearance, beliefs, or background Disparity: Difference in health outcomes between groups within a population, unjust or not5 Ethnicity: characterization based on shared culture (geographical area, beliefs, values, language, etc.) Implicit Bias: Unconscious attitudes or stereotypes that affect our decisions and actions Inequity: Differences in health outcomes that are systematic, avoidable, and unjust5 Intersectionality:22 how multiple social identities (race/gender/class) intersect to create unique experiences PLOE: Preferred Language Other than English Race: categorization based on perceived shared physical traits REaL: Race, Ethnicity, and Language SOGI: Sexual Orientation and Gender Identity Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 VI. Training and Education EDUCATION PRINCIPLES Training and education are essential for the success of quality improvement efforts and are developed collaboratively with quality and training experts from the EMS system. The EMS Medical Director and Deputy Medical Director play a key role in advancing EMS education in Alameda County. As clinical subject matter experts, their knowledge of current EMS studies and practices is crucial for ensuring that educational content remains relevant. This section outlines EMS education efforts, and community outreach which highlights the importance of public engagement during medical emergencies. EMS PROTOCOL UPDATES, TRAININGS, AND EDUCATION Annual Protocol Updates Each year, the Alameda County EMS Agency conducts a train-the-trainer session to teach protocol updates and share training materials. EMS coordinator Carolina Snypes leads the annual policy update project, with guidance from EMS Medical Director Zita Konik, and active participation from EMS Coordinator Naila Francies. The training materials consist of protocol books, and a flash drive containing a PowerPoint slide deck, with each slide featuring an embedded or linked video that explains the content. To reduce the training burden across the county, multiple update sessions are offered, including in-person classes at departments that invite us to teach on-site. Protocols are updated annually and made available via a printed field guideline handbook and a smartphone app for iOS and Android. While updates are limited to once per year, exceptions may occur for urgent patient safety concerns. Refining field guidance through evidence-based best practices and the latest EMS research is central to improving prehospital care. The Alameda County EMS agency created a Protocol Feedback Form, via Smartsheets, in 2024 to continuously collect policy input from EMS clinicians. This form can be found under "Protocol Mobile App & Feedback Requests" in the new Eolas protocol application or on the Alameda County EMS website homepage under "Reports." The updated protocol review process, featuring public comment periods and defined timelines, is scheduled for formal policy development in 2026. 2026 Protocol Updates ; replaced chest pain policy, immediate 12-lead acquisition, no base for nitro Revised ; scene time goal of <15min, immediate transport after STEMI ;Rule of 1’s, updated Pedi fluid volume, and added cool running water for <10% burns Revised ; Inhalation injury included, removed St. Francis as a pediatric burn destination Revised ; clarified guidance on when field pronouncement is indicated Revised ; Consolidated from 1 page to 2, added special considerations for patients w breast tissue Revised ; Amputation section, replaced 'dry' sterile dressing with 'moist' sterile dressing Revised ; Additional pre-eclampsia s/s, shoulder dystocia identification and treatment Revised ; Bup indicated when COWS is ≥5 after Naloxone, or ≥8 without Naloxone Revised ; addition of IV Acetaminophen Revised; no base needed for organophosphate, calcium channel, or beta blocker OD Revised ; SGA preferred airway, additional criteria for sodium thiosulfate Revised Alameda County EMS Agency conducting a 2025 Annual Protocol Update training with the Fremont Fire Department Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Continuing Education EMS coordinator Elsie Kusel manages CE distribution for Alameda County EMS trainings. Once monthly, Alameda County Health Services Highland partners with Alameda County EMS to host Base Tape Reviews. The Base Station Medical Director selects cases that present great learning opportunities and foster important conversations, some of which lead to system-wide policy changes. These sessions are offered ten (10) times a year and are intended to become eligible for one credit of Continuing Education (CE) in the near future. EMS Corps Under the purview of Alameda County Public Health, EMS Corps trains youth from underrepresented groups from our community as Emergency Medical Technicians (EMTs) and prepares them for careers in healthcare and public service. EMS Corps is a 5-month paid program for young people between the ages of 18 and 26. EMS Corps students participate in daily EMT classes, tutoring, life coaching. physical fitness, career development workshops, and are also provided with mentorship support. Alameda County EMS Orientation All EMTs and Paramedics are required to completing an orientation class hosted by Alameda County EMS within 30 days of beginning employment or field training and evaluation process. This orientation is continuously refined to adapt to the evolving needs of the system and is designed to familiarize new employees with local protocols, procedures, specialty receiving centers and the geographical area. EMS Coordinator Gerald Takahashi led the program in 2024, conducting 28 EMS orientations and engaging approximately 200 new EMS clinicians. Preceptor and Field Evaluator Training The Alameda County EMS Agency’s Paramedic Preceptor/Field Training Officer Workshop is a full-day, interactive training that covers learning domains, helps refine teaching strategies, assists in developing internship/training plans and provides teaching scenarios. The workshop is facilitated by experienced, respected paramedic preceptors and field training officers. EMS coordinator Elsie Kusel oversees the preceptor program and completed three Preceptor Workshops training 33 new preceptors, and six Internship Candidate Orientations for 63 participants in 2024. COMMUNITY OUTREACH AND EDUCATION Naloxone Distribution and Fentanyl Testing EMS Coordinator Carolina Snypes established the Leave Behind Narcan and Fentanyl Test Strip Distribution programs in Alameda County. This initiative aims to encourage EMS organizations to obtain free Narcan kits and Fentanyl testing strips through the California Department of Healthcare Services (DHCS) grant and distribute them to anyone who could benefit from having either readily accessible. The distribution is not limited to patients and extends to bystanders, family members, or individuals encountered outside of emergency calls. The Leave Behind Narcan and Fentanyl Testing policy is included in this plan (Appendix G). Stop the Bleed Stop the Bleed is a national awareness campaign created by the American College of Surgeons, that encourages all people to become trained, equipped, and empowered to intervene in a bleeding emergency before medically trained personnel arrive. EMS Coordinator, Elsie Kusel, teaches Stop the Bleed classes for community members and local organizations across the county. Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Injury Prevention The Safe Kids program partners with community organizations to provide public education and assistance for reducing preventable injuries in youth including, Child Passenger Safety, Helmet Safety, and Railway Safety. The Senior Injury Prevention Program (SIPP) partners with community organizations to provide public education and assistance to reduce preventable injuries to older adults including, medication management, fall prevention, bone density screening, home modifications, and physical training sessions. This group is managed by the Injury Prevention program manager, Kat Woolbright. Refer to the Injury Prevention Programs page for more information. Project HEARTSafe Achieving HEARTSafe Community status is a long-term objective for Alameda County, requiring collaboration among cities and districts to complete the 13-step process to improve survival rates from cardiac arrest. This comprehensive program enhances every aspect of the cardiac arrest chain of survival through various community-level initiatives. In 2024, the Alameda County EMS Agency successfully acquired and distributed over 100 Avive AEDs to local law enforcement agencies, an effort led by EMS Medical Director Dr. Zita Konik, and EMS Coordinators Carolina Snypes and Yolanda Takahashi. CPR 7, launched in 2010, is a program designed to teach CPR to 7th-grade students in Alameda County public schools. Following the passage of state legislation in 2015 mandating CPR instruction as a high school graduation requirement, the program laid a strong foundation for this initiative. EMS Coordinator Michael Jacobs is now working to revive and expand CPR7 in Schools in 2025. Social Media Messaging The Alameda County EMS Agency shares information through Instagram, and Meta (Facebook) aligning messaging with special months or days to raise awareness about key issues. Our proposed Social Media Messaging Calendar is included in this plan (Appendix H). EMS Coordinator Naila Francies creates the social media content, which is then reviewed by the EMS Medical Director and approved by the county Public Information Officer (PIO), Troy Espera. EMS Coordinator Kreig Harmon will post the content on each platform and our website. Since 2023, all messaging has been translated into Alameda County’s five threshold languages to ensure its accessibility. Our county offers language translation services through Globo. When all system stakeholders share the same messaging on their social media platforms, the stronger and more impactful that messaging becomes. It is our long-term goal to establish a Public Education and Engagement Committee involving system stakeholders to streamline and share the workload of creating content, maintaining a calendar of community events, and coordinating outreach efforts. Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 VII. Annual Update 2025 CQI UPDATES Summary In response to local system trends and performance indicators, Alameda County EMS Agency made substantial progress in 2025 across both clinical quality and system operations. A major focus was bringing protocol education directly to partner agencies. Six onsite trainings were conducted across multiple provider locations, supporting consistent adoption of annual protocol updates and allowing for direct feedback from field clinicians. The 2026 protocol update continues this work with targeted education on several high-impact areas. This includes clarification of the 2025 traumatic arrest changes, focused instruction on STEMI care, and expanded education on buprenorphine administration. To support this effort, a Substance Use Disorder (SUD) workgroup will be established in 2026, led by Deputy EMS Medical Director Alex Schmalz and EMS Coordinator Carolina Snypes. Alameda County EMS Agency was selected by NAEMSP to present the Quality Improvement poster “Improving EMS Event Reporting and Resolution Through Technical and Interdisciplinary Interventions,” at the 2026 conference. This work reflects the system’s shift from traditional Unusual Occurrences to a modern EMS event reporting and resolution framework that improves transparency, follow-up, and accountability across the EMS system. In partnership with Falck Northern California, we were also selected to present “Every Second Counts: Improving EMS On- Scene Times for STEMI, Stroke, and Major Trauma Activations.” Reducing scene time for time-sensitive patients remains a priority, and a pilot initiative to address this will be launched in 2026. System-of-care governance also continued to evolve. STEMI, Stroke, and Cardiac Arrest committee meetings were expanded to include dispatch metrics, providing a more complete view of the patient care timeline. The digitized EMS Event Reporting process continues to mature, and the agency remains on track to achieve its goal of closing events within 45 days at the 90th percentile. Trauma system coordination also advanced in 2025. Joint Trauma Audit Committee (TAC) meetings with Alameda and Contra Costa Counties are now overseen by Deputy EMS Medical Director Alex Schmalz, supporting closer collaboration across both counties and their five trauma receiving centers. Status of 2025 Goals # Goal Description Status Improve Accuracy for Pediatric Medication Administration Establish and EMS Symposium with system partners Not Complete – 2024 Re-establish Lifeack Codestat and Zoll equivalent with annotation services Discontinued Reduce on scene times for STEMI and Stroke to 90th percentile ≤ 15 min Collect Field Training and Evaluation Plans from all providers Not Complete - 2024 Establish a Community Education & Engagement Meeting with all system partners Discontinued Infrequent and LOSOP skills as condition of continuous paramedic accreditation Not Complete - 2024 Decrease the 90th percentile time of closing EMS events from 76 days to 45 days Increase sending the final resolution to the RP of EMS events from 61% to ≤ 95% Remove “Coroner” as a Destination for Cardiac Arrest in the EHR, and create another way to get vital information to the Alameda County Coroner’s Office 11 Ongoing 12 13 understand why cardiac patients don’t call 911, to inform improvement initiatives Complete 14 Increase use of Language Line interpreter services from 4% to 50% for every documented language barrier impacting care Ongoing Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 2026 CQI GOALS # Goal Description Status Improve Accuracy for Pediatric Medication Administration Ongoing Establish and EMS Symposium with system partners Not Complete – 2024 Reduce on scene times for STEMI and Stroke to 90th percentile ≤ 15 min Ongoing Collect Field Training and Evaluation Plans from all providers Not Complete - 2024 5 6 th 7 Increase sending the final resolution to the RP of EMS events from 61% to ≤95% 8 another way to get vital information to the Alameda County Coroner’s Office 9 10 11 Increase use of Language Line interpreter services from 4% to 50% for every documented language barrier impacting care 12 Increase the administration of Buprenorphine system-wide NEW - Ongoing Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX A: CONTINUOUS QUALITY IMPROVEMENT (CQI) POLICY Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX B: PUBLIC SAFETY ANSWERING POINT (PSAP) ORGANIZATIONAL FRAMEWORK Call Location Primary PSAP Receive 9-1-1 Call Fire 1st Response Dispatch Ambulance Dispatch EMD Provided By Alameda City Alameda Police PSAP Call transferred from PD PSAP to ACRECC who dispatches fire units/ambulances ACRECC dispatches city ambulances ACRECC Alameda County (and areas served by County Sherriff (unincorporated and Dublin); San Leandro Police Calls transferred from various PD PSAPs to ACRECC who dispatches fire units ACRECC dispatches Falck ambulances ACRECC Albany Albany Police PSAP Albany PD dispatches fire Albany PD dispatches city None Berkeley Berkeley PD PSAP (dual police and Berkeley PD dispatches fire units Berkeley PD dispatches city ambulances ACRECC Camp Parks City of Dublin Police PSAP Call transferred from Dublin PD PSAP to ACRECC who dispatches fire units ACRECC dispatches Falck ambulances ACRECC Emeryville Emeryville Police PSAP Call transferred from Emeryville PD to ACRECC who dispatches fire units ACRECC dispatches Falck ambulances ACRECC Fremont Fremont Police PSAP Call transferred from PD PSAP to ACRECC who dispatches fire units ACRECC dispatches Falck ambulances ACRECC Hayward Hayward Police PSAP Hayward PD PSAP dispatches fire units and transfers call to ACRECC ACRECC dispatches Falck ambulances ACRECC Livermore Livermore Police PSAP Call transferred from Livermore PD PSAP to ACRECC who dispatches fire ACRECC dispatches Paramedic Plus ambulances ACRECC Pleasanton Pleasanton Police PSAP Call transferred from Pleasanton PD to ACRECC ACRECC dispatches Falck ambulances ACRECC Newark Newark Police PSAP Call transferred from PD PSAP to ACRECC who ACRECC dispatches Falck ambulances ACRECC Oakland Oakland Police PSAP Call transferred from PD PSAP to Oakland Fire Dispatch who dispatches fire Oakland Fire Dispatch transfers call to ACCREC who dispatches Falck Oakland Fire Dispatch Piedmont Piedmont Police/Fire (Joint PSAP) Piedmont PD/Fire dispatches fire and city ambulances Piedmont PD/Fire PSAP None East Bay Regional Parks EBRP PSAP and dispatch EBRP dispatches Parks units and transfers call to ACRECC or to the transport city PSAPs ACRECC dispatches Falck ambulances; local PSAPs dispatch fire units/ambulances ACRECC Union City Union City Police PSAP Call transferred from PD PSAP to ACRECC who dispatches fire units ACRECC dispatches Falck ambulances ACRECC Cellular Calls CA Highway Patrol Per response jurisdiction Varies by jurisdiction Varies by jurisdiction Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX C: EMS TELEHEALTH GUIDELINES Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX D: QUALITY COUNCIL CHARTER EMS Leadership/Quality Council (QC) Charter The EMS Agency Director works with the EMS Medical Director, EMS QI Coordinator, and the Quality Council to oversee the Alameda County EMS QI program. Quality Council Purpose: • Serves as the Technical Advisory Group (TAG) for Alameda County EMS • Identifies Quality Improvement needs • Charter (and/or serve as) Quality Task Force(s) to improve system-wide processes (also known as Process Improvement Teams) • Provides input for the EMS System Quality Improvement Plan • Develops Quality Indicators • Contributes to the development of a consistent approach to developing quality indicators and gathering and analyzing data • Contributes to the development of a consistent approach to research • Monitors and evaluates system data reports to identify opportunities for improvement and training needs Quality Council Membership: • EMS Medical Director (Chair) • EMS Director • EMS Quality Improvement Coordinator • EMS Quality Improvement Coordinators from each fire department • Private 911 ambulance transport provider Quality Manager • Base Hospital Paramedic Liaison Nurse • One Paramedic and one EMT representing fire department in each of the North, South and East zones of Alameda County (6 total members) • One Paramedic and one EMT from the 911 private medical transport provider agency • One representative from an air transport provider • Two representatives from Receiving Hospitals • One representative each from OFD dispatch and ACRECC • One representative from a permitted IFT provider Quality Council Chairperson: EMS Medical Director Meetings: • Monthly • Two hours with a planned agenda Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX E: ELECTRONIC HEALTH RECORD (EHR) POLICY Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX F: EMS EVENT REPORTING POLICY AND RESOLUTION FORM Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 From: To: Subject: Date: Alameda County Health Smartsheet via SmartsheetReporting Party & Involved Parties Closed EMS Event: Resolution Form mm/dd/yyyy Closed EMS Event: Resolution Form ≥ Event Summary: Actions Taken: Final Resolution: [Sections 1157 and 1157.7 of the California Evidence Code protect the records and proceedings of committees evaluating prehospital emergency care quality from discovery] Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX G: LEAVE BEHIND NARCAN AND FENTANYL TESTING POLICY Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 APPENDIX H: SOCIAL MEDIA MESSAGING CALENDAR Month Day Event Origin January n/a Human Trafficking Awareness Month 2010 Presidential Declaration n/a Black History Month 1976 Presidential Recognition n/a American Heart Month 1964 Presidential declaration 1st Friday National Wear Red Day® 2003 American Heart Association 11th Human Trafficking Awareness Day 2007 Congressional Declaration n/a Sexual Assault Awareness Month 2000 National Sexual Violence Resource Center 2nd Week Dispatcher Appreciation Week 1981 Started in Contra Costa County and was signed as a presidential proclamation in 1991 n/a American Stroke Month 1989 Presidential proclamation n/a Mental Health Awareness Month 1949 Mental Health America 3rd Week EMS Week 1974 Presidential Designation 3rd Week (Wednesday) EMS for Children’s (EMSC) Day 1984 EMSC Program, ACEP, and AAP n/a Gun Violence Awareness Month 2015 n/a Pride Month 1999 Presidential Declaration 1st - 7th CPR and AED Awareness Week 2007 Congressional Declaration n/a National Minority Mental Health Awareness Month 2008 Congressional Declaration 25th World Drowning Prevention Day 2021 United Nations 31st International Overdose Awareness Day 2001 began in Australia n/a Sickle Cell Awareness Month 1983 Congressional Declaration n/a Substance Use Prevention Month 2011 Presidential Declaration n/a Suicide Prevention Awareness Month 2008 Centers for Disease Control and Prevention 8th 988 Day 2024 SAMHSA 10th Suicide Prevention Day 2003 International Association for Suicide Prevention n/a Breast Cancer Awareness Month 1985 American Cancer Society n/a Domestic Violence Awareness Month 1989 Congressional Declaration n/a Sudden Cardiac Arrest Awareness Month 2008 Congressional Declaration 1st Wednesday National Walk to School Day 1997 Partnership for a Walkable America 29th World Stroke Day World Health Organization Alameda County EMS Continuous Quality Improvement (CQI) Plan - 2026 R e v i s i o n D a t e : 1 /2 9 / 2 0 26 P a g e | 44 References 1. 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